Childbirth and Newborn Health

FogelChapter 4 Created by Ilse DeKoeyer-Laros, Ph.D.

Overview Chapter 4

• The Childbirth Experience• The Baby at Birth: Health and Risk• Birth Complications• Perinatal Mortality• Family and Society

Experiential Exercises

The Childbirth ExperienceLabor & Delivery

Labor occurs in three stages: 1. the opening of the

cervix2. the passage of the

infant through the vagina

3. the birth of the placenta

Stages 1 & 2

The Childbirth ExperienceLabor & Delivery

Medical technologies bring risks & benefits (used more in the U.S. than in Europe):

– Fetal monitoring

• does not produce healthier infants with fewer complications & should only be used in high-risk deliveries

– Forceps

• may cause brain and spinal cord injuries if used during early phases of labor (high forceps)

– Vacuum extraction

• risks are lower than with cesarean section or high forceps

The Childbirth ExperienceLabor & Delivery

• In 2004, 29% of births were C-sections

– Necessary under some medical conditions

– Not recommended when unnecessary – recovery takes much longer

• C-sections may be done for doctors’ convenience but this is hard to prove

• There seem to be no ill effects of C-sections compared to vaginal deliveries

The Childbirth ExperienceLabor & Delivery

• Drugs can speed labor & ease pain

• Risks are generally short term & include:

– Epidurals: mothers may develop fevers & are at increased risk for postpartum depression

– Mothers may not remember details of the birth

– Newborns exposed to analgesia (pain relief) were slower to respond to breastfeeding, had higher temperatures & cried more

– General anesthetics can affect newborns’ vulnerable organs (esp. CNS)

The Childbirth ExperienceAlternatives to Hospital Births

• Birthing Centers reduce the need for medical interventions & increase maternal satisfaction

• Home births in the U.S. are no more risky than hospital births (for low-risk births)

Picture from: http://www.birthspirit.org/homebirth.htm

The Childbirth ExperienceAlternatives to Hospital Births

Midwives and doulas

– Can shorten labor, reduce medical interventions, and increase satisfaction & breast-feeding

Picture from: afterconception.com

The Childbirth ExperienceAlternatives to Hospital Births

– upright birthing positions reduce birth complications (e.g., forceps, episiotomies) & pain, shorten labor

– Lamaze system of exercise, breathing, & massage: less pain medication and fewer episiotomies used

Behavioral pain reduction

Picture from: yoga4birthandtherapy.com/page4.htm

The Baby at BirthThe Newborn

Has a unique appearance; needs to learn to self-regulate (e.g., temperature)

– large head, bowed legs, “baby face,” fontanels, and skin may be coated with vernix caseosa & be yellowish due to jaundice

– usually lose weight in the first few days due to the loss of meconium and drinking colostrum instead of milk

Picture from: http://commons.wikimedia.org/wiki/Image:HumanNewborn.JPG#file

Original from EN:WP

The Baby at BirthThe Newborn

Newborn brain:

– virtually all the nerve cells in the brain are present, but they have not developed very far

– during the first year, the brain doubles in size – this is mostly due to the development of a protective sheath around the nerve pathways (myelination), as well as by an increase in neural connections

– the cells that receive fewer inputs and connections will eventually die

The Baby at BirthNewborn Assessment

Three types of assessments:

– Screening assessments (e.g., Apgar) give an indication of the newborn’s ability to survive and whether there are any immediate medical needs

– Neurological assessments test for problems in the newborn’s central and peripheral nervous system, such as major brain, spinal cord, or sensory damage

– Behavioral assessments are used to rate the presence and strength of behavioral responses to stimulation and spontaneous activity

The Baby at BirthApgar Scale

Area 0 1 2

Heart Rate Absent Slow (<100) Rapid (>100)

Respiration Absent Irregular Good, crying

Muscle Tone Flaccid Weak Strong, well flexed

Color Pale Body pink, extremities blue

All pink

Reflex irritability

Nasal tickle No Response Grimace Cough, sneeze

Heel prick No Response Mild Response Foot withdrawal, cry

Birth Complications

• Perinatal problems account for a large proportion of later deficits

– 3-5 children in 1,000 show severe developmental problems before entering school

– about 85% of these can be attributed to prenatal and perinatal causes

• Often, perinatal complications can be overcome with a supportive social & physical environment

Birth Complications

Gestational Age

< 37 weeks Premature

37 weeks or more Full term

Weight less than expected for gestational age

Intrauterine growth retardation

Weight appropriate for gestational age

Birthweight

< 1,000 grams Extremely low birthweight (ELBW)

1,000 - 1,500 gr. Very low birthweight (VLBW)

1,500 - 2,500 gr. Low birthweight (LBW)

Birth ComplicationsPrematurity

• Largest category of birth complications

• Causes include

– Prenatal smoking and alcohol use

– Poor prenatal maternal health or nutrition

– Exceptional stress and persistent family discord

– Infertility treatments that produce multiple births

– Low maternal weight gain also contribute to the incidence of low birthweight

Picture from: piesenlatierra.wordpress.com/tag/smoking/

Birth ComplicationsPrematurity

• Infants born prematurely are at risk for health, motor, and intellectual problems, both in the short term and in the long term

• The youngest and smallest babies run the most risk of complications and death

– ELBW babies

– Babies born under 32 weeks gestational age

Youngest Baby to Survive Baby Amillia Taylor

born at 21 weeks, 6 days (October, 2006)9 1/2 inches long & weighed less than 10 ounces (283 gram)

See www.msnbc.msn.com/id/17304274/site/newsweek/from/ET/

Birth ComplicationsPrematurity

Short-term effects

– newborn death, esp. ELBW babies (67%)

– more likely to have lack of oxygen during birth, jaundice, physical and mental impairments

– gestational age is a better indicator of developmental status than birth age (e.g., feeding, sleeping)

Birth ComplicationsPrematurity

Long-term effects

– shorter & smaller than full-term individuals

– many preemies have deficits that last until middle childhood & adolescence

• problems with behavior, emotional maturity, cognitive functions & educational performance, language, perceptual and motor functions, serious illnesses, and mental retardation

• highest risk with VLBW, extreme illness, or stress within the family

Birth ComplicationsPrematurity

Born in 1989 after just 27 weeks of gestation, Madeline weighed only 9.9 ounces. She entered high school as an honor student and enjoys playing her

violin and rollerblading.See www.cbc.ca/.../2004/08/19/preemie040819.html

Birth ComplicationsPrematurity

Successful intervention depends on gestational age & health

– medical interventions (NICU) are improving

– behavioral procedures are extremely effective in improving health & weight gain at low cost

• e.g., vestibular-proprioceptive stimulation (rocking, breathing teddy bear); sucking on a pacifier; massage; kangaroo care

– parent education is also effective

Perinatal Mortality

• Poverty & disease are the biggest causes of infant mortality worldwide

• Perinatal deaths can often be prevented by

– supplemental nutrition for mothers & infants

– breast-feeding

– growth monitoring

– rehydration

– immunization

Picture from: breastcrawl.org

Perinatal Mortality

• Parents who lose an infant can be expected to grieve in the usual manner

– they should be helped through this process by medical personnel and family

• Euthanasia – the act of causing a painless death or of letting someone die naturally – is controversial if used for newborns with birth defects

Family and Society

• In general, the moods of men and women after childbirth are stable & positive

– most women adjust to the birth of their children rapidly and without long-term psychological effects

– most fathers maintain positive attitudes and show a desire to be involved in the nurture of the newborn

• Post-partum blues are normal & last only a few hours or days

Family and SocietyPostpartum Depression

8-15% of mothers suffer from postpartum depression

– dysphoric mood, disturbances of sleep or appetite, fatigue, feelings of guilt, & suicidal thoughts

– linked to prenatal factors such as life stresses, a perceived lack of support, poor marital adjustment, depressed mood, & a history of psychiatric illness

– need greater emotional support from their partners & have lower levels of marital satisfaction compared to nondepressed women

This involves a variety of rituals that ensure the health of the newborn & mother and carry a blessing for a happy life

Family and Society

Each society has its own unique way of welcoming newborns into the world

Family and SocietyBreastfeeding

• Breastfeeding is recommended until at least 12 months– In 2003, more than 72% of US mothers breastfed at

birth, declining to only 16% at 12 months

• Benefits for mothers:– faster weight loss, lower breast cancer risk

• Benefits for infants: – fussier, but more optimal physiological functioning

– lower risk of infections, cancer, & possibly other diseases, allergies, and obesity

– breast-fed infants get talked to, smiled at, touched, looked at, & rocked more during feeding

Picture from: eideard.wordpress.com/2008/08/12/breastfeeding-study-shows-most-american-moms-quit-early

On the Web

• www.dona.com• www.lalecheleague.org • www.breastfeeding.com • www.chss.iup.edu/postpartum• www.sbpep.org

Experiential Exercises: Feeling Helpless

• Find a friend or relative with a good sense of humor and ask him or her to feed you with a spoon and give you a drink from a cup or glass.

• Try out your repertoire of non-verbal and non-gestural communication skills!

– fuss, cry, make faces, wiggle, turn toward or away, to communicate what you want or don’t want, or like or do not like, about the way they are feeding you

Experiential Exercises: Receiving & Giving Touch

• Choose a partner and find a chair – get to know each other for a few minutes

• One person sits and the other stands behind– when standing, look at the person in front of you with a soft gaze

– place your hands gently on your partner’s shoulders (2 min)

– gently move your hands to another area (2 min)

– experiment with letting your grip go very loose or more intense, then return to the middle ground

– say “goodbye” to your partner with your hands

– close your eyes and notice how your feel

• Change roles silently and repeat

• Discuss in pairs