pregnancy and childbirth labor, newborns, postpartum issues, caring for baby
TRANSCRIPT
Pregnancy and Childbirth
Labor, Newborns, Postpartum Issues,
Caring for baby
LABOR
Early Labor
• Baby settles deep into mother’s pelvis (dropping)
• Losing the mucus plug • Water breaking
– Amniotic fluids’s membrane has broke
• Contractions– Tightening and releasing of uterine
muscle – Braxton Hicks: weeks before actual labor
begins
Stages of Labor
• Stage one: contractions open the cervix
• Stage two: the baby is born
• Stage three: placenta expelled
Stage one: Contractions
• Cervix dilates (widens) to four inches (10 cm) by the end of the stage
• Cervix thins out • Contractions are
approximately 60 seconds long and 5 – 6 minutes apart
• As the cervix opens, baby moves down into the lower pelvis
• Breech presentations – Baby is not head first
• At the end of the stage, contractions last up to 90 seconds and are 2 – 3 minutes apart
• Cervix is fully dilated
• Transition period
Stage two: Here comes baby!
• Can last from minutes to hours • Contractions are moving the baby
down the birth canal • Skull is soft and flexible to allow for
passage (it overlaps) • Episiotomy may be needed • Various birthing positions • Use of forceps
Special Delivery!
• Natural childbirth– Often called
prepared childbirth– The woman learns
about the birthing process so that she knows what to expect
– This reduced tension, fear and pain
Special Delivery!
• Bradley method– Similar to natural
childbirth– Focuses on prenatal
care, deep relaxation, little or no medication, and the father is the coach
Special Delivery!
• Lamaze method – Named after Dr. Fernand Lamaze – Idea is that women are conditioned to fear
childbirth and with Lamaze training, the mother is taught to focus on something other than childbirth
– Mother using breathing pattern to keep mind off pain (deep breathing or panting)
– Mother and coach, usually father, attend classes to prepare mentally and physically
– Mother receive medication if necessary
Special Delivery!
• Water birth – Mother sits in a tub of warm water,
usually heated between 90 & 100 degrees
– During active stage of labor – Physical relief for mother – Transition for baby water temperature is
similar to internal temperature of mother– Some hospitals provide or allow it
Cesarean birth
• Delivery of baby through a surgical incision in the mother’s abdomen
• Used when vaginal delivery is unsafe or there are complications– Mother’s pelvis is too small or not
shaped correctly – Baby’s head is too large – Baby is in incorrect position for birth
• 22% of babies are born this way
Positioning
• Squatting
• Side – lying
• Hands and knees
• Upright
• Standing
• Sitting (rocking or on toilet)
To drug or not to drug?
• Anesthetic: the medication that reduces or eliminates pain
• Systematic: an injection into a muscle or vein that relieves tension, pain and/or nausea (i.e. Demerol)
• Local – Drug injected to numb the vaginal area
when birth is near, an incision needs to be made, or stitches are needed (for example, for episiotomies)
To drug or not to drug?
• Regional: numbs a larger area or region of the body – Epidural: drug given
through a tiny tube placed in the small of the back, just outside the spinal canal
– Spinal: drug administered into the spinal canal, side effects similar to epidural, but may be more dangerous and severe
• General– Drug given
intravenously or by breathing a gas
– Leaves you unconscious
– Used for surgical deliveries
– Has more side effects for mother and baby than other types
– i.e., Cesarean
Stage three: Placenta
• Expelling of placenta– Contractions help placenta detach from
uterine wall
• Can last from two minutes to thirty minutes post – birth
NEWBORNS
Newborn at birth
• Begins breathing
• Umbilical cord is no longer needed
• Blood circulating throughout entire bordy
• Physical appearance – Wobbly, lopsided and
pointed head– Soft spots on head
called fontanels • Open spaces where the
bones of skull have not yet permanently joined
– Fat cheeks– Short, flat nose– Milia
• Small, white bumps caused by plugged oil ducts
Premature babies
• Less than 5 ½ pounds or born before 36 weeks
• Incubator placement
• Heart and lungs monitored
Reflexes
• Rooting reflex– Automatic response when touched on the lips or
cheek – Turns toward touch and begins to suck
• Grasp reflex – Newborn’s hand closes around anything that
comes in contact with palm
• Startle reflex – Legs thrown up, fingers spread, arms extended
and then brought rapidly back while the fingers close in a grasping action
– Do this in response to a loud noise or a touch on the stomach
POSTPARTUM ISSUES
Mom post – birth
• Important for Mommy and baby to bond
• Mommy will produce colostrum– First breast milk that has important
antibodies to protect against disease
• Emotional health
Bonding with Baby
Bonding with Mommy• Skin – to – skin contact • Eye – to – eye contact • Talk to your baby • Feeding, especially if
breastfeeding
Bonding with Daddy• Participating in labor
and delivery • Feeding • Reading or singing to
baby • Letting baby touch
you
3 categories
• Baby blues
• Postpartum depression
• Postpartum psychosis
Baby Blues
• Occurs within the first 2 weeks after giving birth
• Between 50 and 80% of all new mothers experience baby blues
• Because this disorder is so common, it is commonly not classified as a postpartum mood disorder
Baby Blues: How can I tell?
• Weepiness
• Mood swings
• Irritability
• Anxiety
• Loneliness
• Restlessness
• Impatience
Baby Blues: Why me?
• Attributed to: – A sudden change in hormones
– Emotional and physical hardships of giving birth
– Fatigue
Baby Blues: How can I get over it?
• Exercise
• Eat healthy
• Take some “me” time
• Split up parenting responsibilities, if possible
Postpartum Depression
• Affects approximately 10% of new mothers
• Progresses off of baby blues – If your baby blues lasts longer than 2
weeks
Postpartum Depression: Symptoms
• Loss of appetite
• Insomnia
• Intense irritability or anger
• Overwhelming fatigue
• Lack of joy in life
• Feelings of guilt, shame and inadequacy
• Difficulty bonding with baby
• Thoughts of harming yourself or baby
Postpartum Depression: Why me?
• Changing hormone levels
• Difficulty breastfeeding
• Sick baby
• fatigue
• Risk factors – History of depression – PPD after previous
pregnancy– Unplanned/unwanted
pregnancy – Marital conflict – Pregnancy/previous
stressors – Weak or no support
system
Postpartum Depression: Help is on the way
• Medications
• Therapy
• Possible hospitalization
Postpartum Psychosis
• The mother loses touch with reality
• Afflicts 1 to 2 women per 1,000 live births
Postpartum Psychosis: Symptoms
• Confusion
• Disorientation
• Hallucinations
• Delusions
• Paranoia
• Attempts to harm baby and/or self
Postpartum Psychosis: Will I be affected?
• Risk factors – History of depression – History of psychosis – Previously had PPP with another
pregnancy – History of bipolar disorder – History of other medical problems /
imbalances
Postpartum Psychosis
• So will 1 to 2 every 1,000 children be killed by their mothers?
– Infanticide is rare
– Many PPP sufferers do not act upon their homicidal thoughts
– Reportedly occurs in less than 1 per 50,000 live births
Postpartum Psychosis Help
• Treatment includes
– Medications
– Therapy
– Immediate hospitalization
References
• http://www.mayoclinic.com
• http://www.alegent.com
• http://www.pregnancy-info.net
CARING FOR NEWBORN
Caring for a newborn
• Food
• Sleep
• Exercise
• Safety
• Bathing
• Medical care
• Toys
• Love
Temperament
• Way they react to the world and others
• Be sensitive to a baby’s individual style
SIDS
S udden
I nfant
D eath
S yndrome
• Also known as “crib death”
• Victims are typically healthy infants between 2 weeks and 6 months
• Infants die in their sleep with no warning, no cry, and no evidence of pain
SIDS
• To reduce the risk of SIDS– Place infants on their backs for sleep– Provide a firm crib, covered by a sheet– Keep soft materials, such as comforters,
pillows, and stuffed toys out of the crib– Make sure the sleeping area is a
comfortable temperature to keep infants from becoming overheated
Shaken Baby Syndrome
• Signs and symptoms resulting from violent shaking or shaking and impacting of the head of an infant or small child.
Shaken Baby Syndrome
What Happens: • The brain rotates within the
skull cavity, injuring or destroying brain tissue.
• When shaking occurs, blood vessels feeding the brain can be torn, leading to bleeding around the brain.
• Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing additional brain damage.
• Retinal (back of the eye) bleeding is very common
Why? • Babies' heads are relatively
large and heavy, making up about 25% of their total body weight. Their neck muscles are too weak to support such a disproportionately large head.
• Babies' brains are immature and more easily injured by shaking.
• Babies' blood vessels around the brain are more susceptible to tearing than older children or adults.
Symptoms of SBS
• Lethargy / decreased muscle tone
• Extreme irritability • Decreased appetite,
poor feeding or vomiting for no apparent reason
• Grab-type bruises on arms or chest are rare
• No smiling or vocalization
• Poor sucking or swallowing
• Rigidity or posturing • Difficulty breathing • Seizures • Head or forehead
appears larger than usual or soft-spot on head appears to be bulging
• Inability to lift head • Inability of eyes to
focus or track movement or unequal size of pupils
Consequences of SBS
Immediate• Breathing may stop or be
compromised • Extreme irritability • Seizures • Limp arms and legs or
rigidity/posturing • Decreased level of
consciousness • Vomiting; poor feeding • Inability to suck or swallow • Heart may stop • Death
Long Term• Learning disabilities • Physical disabilities • Visual disabilities or
blindness • Hearing impairment • Speech disabilities • Cerebral Palsy • Seizures • Behavior disorders • Cognitive impairment • Death
COPING WITH CRYING
SHAKEN BABY SYNDROME
What do BABIES do?
EatSleepHave dirty diapersCry
Most babies cry 2-3 hours a day for the 1st 2 -3 months of life
5 p.m. to Midnight is often a fussy time
A parent responding to an infant’s cry is a vital part of
EMOTIONAL NURTURING.
It will help the baby to learn to TRUST and BOND with the parents or
caregivers.
4 Basic Cries:
… the HUNGRY CryRhythmical rise & fall - demanding not
desperate
… the CRY of PAINLoud gasp - shrieks
… the BORED or GRUMBLING CRYLow pitched - not demanding - increases
when ignored
… the ANGRY CRY Loud - demanding - not a type of cry until
about 6 months of age
Check to see if Basic Needs are met:
HungryBurpedDiaper ChangeClothing ComfortableCrying to release Stress (Pacifier)Wants to be heldRoom too hot or cold
Check to see if baby is SICK-
TemperatureGums:
swollen - red - drooling (teething)Ears
Red - warm - drainingVomitingDiarrheaAllergies
Runny nose - red eyesClear = Allergies Green = Infection
COLIC:
Pull legs up to stomach stomach problems / gas
Breast Feeding onions, garlic, broccoli, cauliflower, spicy foods,
chocolate, etc.
LACTOSE Intolerance: √ with doctor / Change formula (soy or goat)
Often Outgrows colic by 3-4 months more movement and solid food
When the Caregiver is tired & Baby Cries a lot:
Natural to feel FRUSTRATED
High Risk of
LOOSING CONTROL
PLAN AHEAD WHAT TO DO!
BRAINSTORM ways toCOPE with CRYING
SHAKEN BABY SYNDROME:
Term used to describe the many signs and symptoms resulting from the violent shaking of an infant or young child.
1) Baby’s brain bangs against skull. 2) Small blood vessels are torn - bleeding3) Blood clots press on brain.4) Vertebrae crush thespinal cord.
BRAIN DAMAGERETARDATIONLEARNING DISABILITIESPHYSICAL DISABILITIESPARALYSIS BLINDNESSand DEATH may occur.
SIGNS & SYMPTOMS of SBS
ConcussionVomitingIrritabilityLethargyTrouble feedingSleepycoma
STATISTICS:
70% of the perpetrators are MALE (father, step-father, boyfriend, etc.)
56% of the victims are male babies Average age of shaking is 3-8 months 26 SBS cases in Utah in year 2000
(up from 13 in 1999) 25% of the SBS victims die immediately after being
shaken 75% will live with complications because of the shaking. SBS is the leading cause of death in infants due to child
abuse/neglect.
28% surviving victims return to THEIR HOMES.
11% adopted by GRANDPARENTS
11% placed in FOSTER CARE
Dr. William M. Palmer(Medical Director of the Child Protective Team at Primary Children’s
Hospital & University Hospital)
“Most people do not intend to hurt the child. They lose their impulse control; they just want the baby to shut up.”
A HAND SLAP on the face of an infant under 15 months can cause similar damage
THROWING a child up in the air and catching it
TWIRLING a child under age 2 by it’s arms or legs
BOUNCING ROUGHLY on knee/foot can also have damaging affect on baby
HELPFUL HINTS:
ALWAYS support the neck of infants, babies and small children.
If upset - CALM DOWN before dealing with your child.
When playing, never THROW or TOSS your child.
Screen all babysitters carefully. Know their temperament.
Never
Never
Never
NeverShake a BabyOr TODDLER!
USOE Child Development Curriculum, 1994
The Child Abuse Prevention Centerwww.capcenter.org
Davis County Health [email protected]
www.dontshake.com