CHAPTER 5 Birth

EXPLORING THE BIRTH PROCESS STAGES OF BIRTH: First stage lasts 12 to 24 hours with uterine contractions beginning. Second stage – Baby’s head moves through cervix and birth canal – baby is born. Third stage (afterbirth) is expelling of placenta, umbilical cord, and other membranes.

The Fetus/Newborn Transition – Baby undergoes considerable stress during the birth process. Large quantities of adrenaline and hormones are secreted to protect the newborn.

Childbirth Strategies and Decisions – U.S. mothers predominantly have their babies in hospitals with physicians (99 percent). Hospitals are becoming more sensitive to the needs of the family by creating birthing centers and attempting to re-personalize the process. More midwives are involved.

Delivery Methods Medicated – Analgesia to relieve pain Natural – Increased education on birthing without medication (Lamaze, Dick-Read) Cesarean – Necessitated by baby’s position, mother condition, and/or physical capability Fathers – More involved – often the coach Siblings – Attempts to be more sensitive to their needs – educating parents on the impact.

Low-Brithweight Infants – weigh less than 5.5 pounds at birth. One in 13 babies born in the United States is low-birthweight. Preterm infants – born three weeks or more before full term Small-for-date infants – birhtweight below normal – some may be full term

Long-Term Outcomes for Low- Birthweight Infants – Normal and healthy, but more apt to have developmental problems. Brian weight is correlated with cerebral palsy and/or increased likelihood of brain injury. More likely to have liver and lung diseases. More likely to have learning disabilities. Some low-birthweight deficiencies can be reversed.

Stimulation of Pre-term Infants – Adverse effects of maternal deprivation reversed practice of not stimulating pre- terms. Very immature infants should not be stimulated. Behavioral cues may determine appropriate stimulation. Sensitivity to socioeconomic and cultural factors.

MEASURES OF NEONATAL HEALTH AND RESPONSIVENESS Apgar scale is generally used to determine an infant’s immediate health status – heart rate, respiratory effort, muscle tone, body color, and reflex irritability. Brazelton Neonatal Behavioral Assessment Scale – 27 evaluations to measure reflexes, responses, and general neurological development.

THE POSTPARTUM PERIOD The six-week period following birth in which the mother adjusts physically and psychologically to the birth process.

Physical Adjustments Involution – uterus returns to pre- pregnancy stage. Hormone production is interrupted and must recover. Exercise greatly aids quick return to physical strength and body tone.

Emotional and Psychological Adjustments Emotional fluctuations caused by hormonal shifts. Depression, worrying, appetite change, crying spells, and sleep irregularities are all possible. Return-to-work factor must be considered. Father’s reaction to wife’s attention to newborn.

Bonding – the close physical and emotional contact between infant and parents Bonding may be thwarted by the use of drugs during delivery. Research is conflicted on the importance of bonding.