1. 1 Prenatal Care and Childbirth Chapter 5

2. 2 At no other time are two people closer than a mother and baby during prenatal period Even before she knows she’s pregnant her body is undergoing changes to prepare for the 9 months

3. 3 Mother gives the baby a safe “home” in her uterus She eats, breathes, and gets rid of wastes for them both, her body works to bring the baby into the world

4. 4 “Be good to your baby before it is born.” Parents to be should take this slogan seriously Ideally, these steps should begin before a woman becomes pregnant

5. 5 Good health habits in younger years are beneficial Complete physical check up As soon as you realize your pregnant go for prenatal check up Reduces risk of complications

6. 6 Signs of Pregnancy Can’t feel sperm and egg unite Can’t feel cells dividing Body begins to nourish and protect new life Hormones trigger changes in some woman’s organs

7. 7 Signs of Pregnancy Presumptive – can be signs of pregnancy or something else Amenorrhea Nausea Tiredness Frequent urination Swelling/tenderness of breasts Internal changes other signs See page 131 figure 5-1 Positive signs – HCG – hormone in blood and urine Fetal heartbeat Fetal movement Fetal image Fetal shape Uterine contractions

8. 8 Medical Care Obstetricians – doctors who specialize in pregnancy and birth The first appointment- couple should go together Gather general information Details on menstrual cycle Past pregnancies Complete physical exam Weigh the woman, blood pressure, respiration Pelvic exam Urine and blood tests (anemia) Blood sugar test Due date estimated

9. 9 The Unborn Baby’s Environment At conception, baby begins to form traits from both mom and dad Inherited traits merged into one person Influence child’s growth and development Environmental factors – those factors caused by a person’s surroundings The mother’s age, weight, health habits, and hazards she encounters affect the baby

10. 10 Factors that Affect the Baby’s Health Unborn relies on mom Healthy mom usually means healthy baby High risk mothers have factors that don’t promote a healthy pregnancy Age, physical health, Rh factor, emotional stability

11. 11 Mom’s age Ideal time to have a baby is 21 to 28 Teens and women over 36 are high risk Pregnant teens are still growing themselves (can’t always meet babies needs) Premature – babies born too soon Low birthweight – babies who weigh less than 5 ½ pounds at birth Women over 36 tend to have babies with health problems, disabilities and disorders

12. 12 Mother’s Physical Health Affects the outcome of pregnancy Learn how the health problem may affect the pregnancy Take steps to protect the baby Special testing etc Healthy weight important Low weight (15%) can lead to low birthweight (20%)May experience fatigue, high blood pressure, heart strain and blood sugar problems

13. 13 Weight cont Having a healthy weight and good exercise important Good nutrition a must

14. 14 Rh Factor Protein substance found in the red blood cells of about 85% of the population (found in Rhesus monkey) Rh + and Rh – Problem when father is + and mom is – 12% of marriages Baby may develop Rh disease (anemia that destroys the baby’s red blood cells

15. 15 Rh Rh + baby affects mom for later pregnancies She builds up antibodies to fight the + in her – system Anti Rh immune globulin was approved to help Receive within 72 hours after the birth of each Rh + child

16. 16 Mother’s Emotional Health Positive thoughts and feelings important Negative feelings stimulate the nervous system Adrenaline is a hormone that prepares the body for stress Feel more energetic, controls heart rate, breathing and muscle tension

17. 17 Happy mom = lower adrenaline Later in pregnancy if mom has adrenaline so does the child and hears mom’s increased heart rate and muscle tension Unborn can handle some stress Long term and severe or frequent can make delivery more difficult Baby may be smaller, fussy or quite active

18. 18 Health Habits During Pregnancy Good health as for all people May need to eat more of some foods May need vitamins Be cautious about physical activities Ask doctor for guidelines

19. 19 Nutrition “eating for two” is correct First week baby relies on yolk sac By 12 th week relies on mom Shouldn’t double your calories but definitely eat more

20. 20 Good nutrition is vital Direct link between what she eats and the following: –Her weight gain –Unborn’s weight gain –Infant’s growth –Infant’s mental capacity –Infant’s physical performance

21. 21 Diet is essential Food Guide Pyramid for help Diets need more calcium, iron, folic acid, and protein than non pregnant Limit caffeine See page 138 figure 5-5

22. 22 Weight Gain 25 – 35 pounds in pregnancy Need 300 extra calories a day Weight gain during pregnancy is not all stored as fat Doctors watch the weight gain Too little and baby not growing Too much puts strain on mom’s heart

23. 23 Weight Gain During the first 3 months = 5 pounds 4 to 8 months = 2 – 3 pounds per month During the 9 th month = 1 pound per week

24. 24 Hygiene Practices Continue good and normal grooming Paying attention to appearance makes her feel better Dental check up Avoid very cold or very hot baths Replace tub baths with showers or sponge baths during the last 4 to 6 weeks (possible internal infection or falls)

25. 25 Rest & Sleep Needs rest and sleep 8 – 9 hours a night 15 – 30 minutes rests during the day Many feel tired and its good to rest

26. 26 Physical Activity & Exercise Limit physical activity Be active but within normal limits Avoid contact sports Activities that jolt the pelvic area Activities that could result in a fall Childbirth classes help women learn conditioning exercises to relieve back and leg strain and prepare muscles for delivery

27. 27 Health Hazards to Avoid 20% of disabilities present at birth are caused by genetic factors Most caused by environment: Diseases, drugs, radiation, pollutants

28. 28 Diseases or Illnesses in the Mother Diabetes – body’s inability to use sugar properly Gestational diabetes – it appears in women who are pregnant- goes away after pregnancy –Have larger babies (10 – 12 lbs) –Babies have higher risk high blood pressure, congenital problems, heart problems, and infant death

29. 29 Pregnancy-Induced Hypertension (PIH) High blood pressure caused by pregnancy Dangerous condition Preeclampsia or toxemia Sudden increase in blood pressure, protein in the urine and swelling Appears late in pregnancy, cause is unknown Untreated can lead to damage or death of mom and baby or both Medicine, bed rest

30. 30 FYI It can cause your blood pressure to rise and puts you at risk of stroke or impaired kidney function, impaired liver function, blood clotting problems, pulmonary edema (fluid on the lungs), seizures and, in severe forms, maternal and infant death. Because preeclampsia affects the blood flow and placenta, babies can be smaller and are often born prematurely. Ironically, sometimes the babies can be much larger. While maternal death from preeclampsia is rare in the U.S., it is a leading cause of illness and death globally for mothers and infants.

31. 31 Rubella and Other Infections Rubella – German measles – virus that can cross the placenta and affect baby the first three months Baby can be born blind, deaf, mentally disabled or heart problems Also concerned about chicken pox, mumps and measles Mom should have vaccine if possible Don’t be exposed to these

32. 32 Toxoplasmosis – caused by a parasite that primarily infects cats Damages unborn’s nervous system Avoid contact with cats Garden with rubber gloves Don’t change the cat’s litter boxes

33. 33 Sexually Transmitted Diseases Infectious illnesses that are passed primarily through sexual intercourse STD’s may enter blood stream of mom and cross placenta to baby Others infect mom’s reproductive tract and pass to baby through delivery Others passed during breast feeding See page 142 figure 5-8

34. 34 All STD’s are danger to baby Acquired Immunodeficiency syndrome (AIDS) Most dangerous Disease caused by human immunodeficiency virus (HIV) attacks body’s immune system Passes through sex, blood and body fluids, delivery, breastfeeding Prevention no cure

35. 35 Drugs Medications – alcohol, nicotine, illegal drugs Medications – don’t use unless doctor directed Some affects not know Case by case whether the risk is worth it

36. 36 Alcohol Never drink Any liquor can harm unborn Fetal alcohol syndrome (FAS)- condition in infants that occurs when mothers drink heavily during pregnancy –Babies are shorter, weigh less –Growth/development slow –Small heads, unusual facial features, heart defects, poor motor development and disabilities –No one knows how much is safe –IS IT WORTH IT????

37. 37 Nicotine Babies feel effects of smoking Usually smaller in size Nicotine raises mom’s heart rate, blood pressure, breathing rate and reduces the flow of blood While mom is smoking, baby’s oxygen is greatly reduced Need O2 to grow Smoking after 16 weeks can lead to a miscarriage Smoking can cause baby’s brain to develop abnormally Learning problems, hyperactivity and poor attention spans Ear infections and breathing problems Second hand smoke just as dangerous

38. 38 Illegal Drugs Cocaine, crack, heroin, marijuana All cross placenta quickly and reach baby If woman is addicted, her child will likely be also Babies goes through withdrawal –high-pitched crying, shaking poor feeding and fever –Mothers eat poorly, smoke or abuse alcohol –Slim chance of living a healthy life

39. 39 Radiation Exposure X rays should be avoided Can increase childhood cancer Linked to congenital disabilities Inform doctors and dentists of pregnancy Avoid X rays and don’t work by them

40. 40 Environmental Pollution Home and workplace should be safe Lead, chemicals, pesticides and herbicides pose risks to unborn baby

41. 41 Complications of Pregnancy Reduced by good prenatal care Follow doctor’s advice Practice good health habits Complications can damage the mother’s health Cause congenital problems or loss of baby before birth

42. 42 Congenital Problems Physical or biochemical problem that is present at birth and may be caused by genetic or environmental factors Inherited or caused by environmental factors Figure 5-10 lists most common

43. 43 Miscarriage Expulsion (forcing out) of the baby from the mother’s body before week 20 of pregnancy (spontaneous abortion) Stillbirth – is the loss of a fetus after 20 weeks of pregnancy (born dead) 1/3 of pregnancies end in loss of baby most common in the first 3 months Can occur before you know you are pregnant

44. 44 Miscarriages result from congenital problems of the fetus Pregnancy complications and certain diseases Smoking, drinking, using drugs lead to fetal loss Risk of a second miscarriage is higher for couples who have had one

45. 45 Monitoring Baby’s Development Help doctors determine baby’s health and exact age Indicates size and gender of baby Determine if one or more babies Babies position

46. 46 Ultrasound Prenatal test in which sound waves bounce off the fetus to produce an image of the fetus inside the womb Sonogram (picture of the fetus) Technician holds a transducer over the mom’s abdomen Produces visual image of fetus Considered safe Fairly routine

47. 47 Chorionic Villus Sampling Prenatal procedure for finding abnormalities in the unborn by testing a small sample of the chorion Between weeks of 8 to 12 Detects serious problems in fetus Hollow tube inserted through vagina into uterus and guided to chorion Small section suctioned off and analyzed Slight risk for infection and miscarriage

48. 48 Amniocentesis Prenatal test in which a needle is inserted through the woman’s abdomen into the amniotic sac and sample of the fluid is removed for cell study Checks for Down syndrome, Tay-Sachs disease and sickle cell anemia 14 -16 weeks Safe in 99% of cases Miscarriage and premature births may result Not a routine test Only when problems are suspected

49. 49 Tay sachs disease a baby with Tay-Sachs disease is born without one of those important enzymes, called Hexosaminidase A (Hex A). So, as those fatty proteins build up in the brain, they hurt the baby's sight, hearing, movement, and mental development.

50. 50 Sickle cell anemia occurs when an abnormal form of hemoglobin (HbS) is produced. HbS molecules tend to clump together, making red blood cells sticky, stiff, and more fragile, and causing them to form into a curved, sickle shape. Red blood cells containing HbS can go back and forth between being shaped normally and being sickle shaped until they eventually become sickle shaped permanently. Instead of moving through the bloodstream easily, these sickle cells can clog blood vessels and deprive the body's tissues and organs of the oxygen they need to stay healthy.

51. 51 Role of the Family Fathers to be who are involved in pregnancy and birth are more likely to be involved in later parenting Children enjoy preparing for new arrival Helps lessen their jealousy of new sister or brother

52. 52 Family Involvement Past times – fathers called the doctor and took wife to hospital Families not allowed in Father handed out cigars and looked through nursery window

53. 53 Today’s Fathers More active roles Help select doctor Decide aspects about delivery May help decorate nursery, etc Fathers need to be supportive Get educated by reading books and attending classes

54. 54 Fathers in delivery room Mothers need helpers in room Labor – process that moves the baby out of the mother’s body Mothers with helpers have shorter and more enjoyable labors

55. 55 Helpers reduce anxiety Anxiety causes blood chemistry changes: –Decrease the flow of blood to the baby, which can harm the baby –Slow contractions, which results in a longer labor Final benefit is the bonding of father, baby and mom

56. 56 Family Decisions Concerning Childbirth Home VS Hospital delivery Home delivery was the norm Hospital deliveries are now the norm Women wanted relief from pain and safer conditions Home birth have begun to increases in the past few years

57. 57 Home VS Hospital More control over child’s birth Hospitals lack warmth Certified nurses-midwives (received special training in delivering babies during NORMAL pregnancies 10 – 15% need special medical help Some state home births are illegal Offer birthing rooms which is like a family bedroom Family members/close friends can stay Homelike setting and safe

58. 58 Delivery Methods Discuss decision with doctor All methods try to make labor and delivery safer and more comfortable for mom and baby Labor is hard work Uses many muscles Pain a part of labor If muscles are tense more intense pain

59. 59 Labor Ranges from quick and easy To long and painful Options may change during labor Cope with pain by using breathing and relaxation techniques Drugs may be necessary Types of drugs are described in 5-13 Helper helps with decision, mom may not be able to

60. 60 Natural Childbirth Pregnant woman learns about the birth process and uses breathing and relaxation techniques to reduce fear and pain Dr Grantly Dick-Read, English physician Decided part of pain was due to fear Father plays an active role

61. 61 Lamaze Method Pregnant woman is trained to use breathing patterns to keep her mind off pain Dr. Fernand Lamaze, French doctor He felt women are conditioned to fear childbirth and are taught to focus on something other than pain Mom uses breathing patterns Helper is a coach Prepares her mentally and physically

62. 62 Lamaze Method Woman’s coach – father or other person Learns breathing patterns –Woman receives medication when necessary –Not all deliver without drugs Training in childbirth given in small classes Factual information, teaches breathing and encourages talks about their feelings

63. 63 Leboyer Method Focuses on making the baby as comfortable as possible during and immediately after delivery Assumes delivery is painful for baby as well Low lighting Noise kept low After birth baby rests on mom Umbilical cord cut only after it stops functioning Few minutes after birth baby is lowered into water that is near body temperature Baby moves and kicks about as it did before

64. 64 Time to Be Born Months of preparing and waiting Final touches on nursery Final natural preparations, hormones change, baby moves into position Labor takes parents by surprise First contractions are so mild that many parents still wonder if the time has really come

65. 65 Last Weeks of Pregnancy 270 days after conception Series of contractions – uterine muscles move the bay out of the mother’s body Involuntary movement Contractions happen in intervals Separated by periods that allow the mother’s muscles to relax

66. 66 Contractions Early labor – last 30 seconds Length increases to 1 minute Strength increases until the baby is born Lightening – change in baby’s position, uterus settles downward and forward, baby descends lower into pelvis –Mothers can breathe easier now –May need to urinate more

67. 67 Breech birth position – buttocks first position in which some babies enter the birth canal False labor – irregular contractions

68. 68 Other Signs of Labor 1. Mom may feel a burst of energy due to increased adrenaline 2. Mucous plus in cervix will become loose –Small amount of blood in mucous call the show (labor will start within 24 hrs) 3. amniotic sac may break –Don’t bathe if either 2 or 3 happens –Don’t eat or drink liquids

69. 69 Stages of Labor Stage One – dilation of the Cervix (cervix opens) 15 to 20 minutes and last about 30 seconds Uterus narrows Straightens babies body and presses head against cervix If the amniotic sac has not broke, the doctor will break it When cervix is completely open, first stage has ended Lasts 8 hours

70. 70 Stage Two- Delivery of the Baby Baby’s head enters the birth canal Mom’s muscles push to move baby down Walls of upper part of birth canal are elastic Lower canal causes resistance (pain) Episiotomy – incision made to widen the birth canal and prevent tearing Closes with sutures

71. 71 Stage Two Baby’s head down and then rotates to the side Shoulders, abdomen and legs follow Second stage ends when the baby is free of mom’s body Lasts 30 to 90 minutes

72. 72 Stage Three – Delivery of Placenta 20 minutes after birth Irregular contractions Expels placenta (afterbirth) Mom feels cold and physically tired Emotionally relieved and overjoyed

73. 73 Complications of Delivery See page 161 figure 5-16 Most deliveries occur without complications Special medical care might be required 1. Version – manually rotating unborn baby into correct position for delivery 2. Drug oxytocin – can speed up labor by causing contractions to start or strengthen

74. 74 3. Forceps – curved instrument that fits around sides of baby’s head, doctor use to ease baby down birth canal during contraction 4. Vacuum extraction – suction used to attach a cuplike device around top of baby’s head so doctor can gently pull baby down birth canal

75. 75 Cesarean Births Delivery method in which the mother’s abdomen and uterus are surgically opened and the baby is removed 22% of births in the U.S.

76. 76 Reasons for C Section Mom’s pelvis is too small, shaped incorrectly Baby’s head is large Contractions are weak or absent Baby is in an incorrect position for birth Doctor feels that previous C section scar could rupture during labor

77. 77 Hospital Care Mom and baby remain in hospital 24 to 48 hours Complications have longer stays Today hospitals allow family centered rooming in policy Nurses available if they are wanted Mom and father and kids all together Other visitors limited to certain hours

78. 78 Bonding Developing a feeling of affection First hour after birth most sensitive bonding time continues during next few weeks

79. 79 Postpartum Care Care the mom receives during the 6 to 8 weeks following the birth of her baby Mom’s body returns to normal First hour after birth, vital signs of mom are monitored Encouraged to get out of bed within 24 hrs after delivery

80. 80 After a few days mom can start doing certain exercises to tone abdominal muscles Rest is important Nursing mom’s should not diet Eat right to gain strength

81. 81 Timesaving Steps Have a friend watch baby so you nap Pack away nonessential items that add to housekeeping time Prepare and freeze meals before baby comes to use after baby is born Use disposable dishes and plastic utensils for a few days or weeks

82. 82 Postpartum Mood Disorders 15 to 25% experience “baby blues” Twice as common in women as in men Many women are aware of mood changes that occur with menstrual cycle

83. 83 Problems for disorder: An inherited tendency for mood disorders Dramatic changes in body chemistry after giving birth that affect the brain Stress caused by caring for a new baby while recovering from pregnancy and delivery

84. 84 All women at risk Some are more at risk Increased by: –Being a teen or over 40 yrs of age –Family history of mood disorders –Family history of thyroid problems –Mood swings during menstrual cycle (PMS)

85. 85 –Migraine headaches when taking hormones (birth control pills) –Fertility problems –Severe family stress –Lack of support from family and friends –Previous postpartum mood disorder

86. 86 Baby blues – mild postpartum mood disorder that goes away on its own Postpartum depression (PPD) serious form of depression, less frequent Postpartum psychosis (PPP) an extremely severe mental illness PPD & PPP need immediate medical treatment See page 167 figure 5-20

87. 87 Teamwork Develop a brochure for pregnant women Include sheets of information she would need to give her doctor See a\page 170 #1

88. 88 Technology Use the Internet to research a congenital problem. Compose a report on this problem using a word processing program on the computer