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Chapter 4:

PrenatalDevelopment

and Birth

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Prenatal

Development

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Prenatal development is dividedinto 3 periods and lasts

approximately 266 days:

Germinal period: first 2 weeks afterconception, zygote created.

Embryonic period: occurs from 2 to 8weeks after conception.

Fetal period: begins 2 months afterconception and lasts until birth.

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2008 The McGraw-Hill Companies, Inc. All rights reserved.

Significant Development in the Germinal

Period

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The Placenta and the Umbilical

Cord

19 i h

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To32wks

Less than1/10th of aninch long

Less than1 inch long

About 16.518 incheslong, weighs4 to 5 pounds

19 incheslong, weighs6 pounds

About 5.5inches long,weighs about4 ounces

About 10-12inches long,weighs 1/2to 1 pound

About 11-14inches long,weighs 1 to1.5 pounds

About 14-17inches long,weighs 2.5to 3 pounds

About 3inches long,weighs about1 ounce

Thirdtrimesterbegins

Second trimester begins

Firsttrimesterbegins

The ThreeTrimesters

of PrenatalDevelopment

See Figure4.3 intextbookfor moredetails

Fig. 4.3

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Prenatal Development

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Issue of Abortion

Beliefs and words seasoned with love

If strongly opposed, then what alternativesare you offering.

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Teratogen: any agent that causesbirth defects: Drugs (prescription, nonprescription). Alcohol, tobacco. Environmental pollutants. Infectious diseases. Nutritional deficiencies.

Maternal stress. Advanced age of a parent.

Severity of damage to the unborndepends on: Dose. Time of exposure. Genetic susceptibility.

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Mostserious

damagefromteratogens

in first2-8 wks

Zygote Embryonic period (wks) Fetal Period (wks)

Period of susceptibilityto functional defects

Period of susceptibilityto structural defects

Fig. 4.4

1 2 3 4 5 6 7 8 9 16 32 38

Teratogens and Timing of TheirEffects on Prenatal Development

Central nervous system

Heart

ArmsEyes

LegsEars

Teeth

Palate

External genitalia

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Fetal alcohol syndrome:abnormalities in newborn dueto mothers heavy use of

alcohol in pregnancy.

Abnormalities include:

Facial deformities.

Defective limbs, face, heart.

Most have below-averageintelligence.

Some are mentally retarded.

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Moderate drinkers during pregnancyhad babies who were less attentive

and alert even at 4 years of age.

Maternal smoking can cause :

respiratory problems.

SIDS.

ADHD.

low birth weight.

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Illegal drugs that harm duringpregnancy:

Cocaine. Marijuana.

Heroin.

Incompatible blood types (Rh factor).

Environmental hazards: exposure toradiation or chemicals.

STDs, HIV infection, AIDS.

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Fetal Alcohol Syndrome

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Other Parental Factors

Maternal factors:

Maternal diet and nutrition.

Emotional states and stress.

Maternal age.

Paternal factors:

Paternal exposure to teratogens including

smoking. Paternal age.

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2008 The McGraw-Hill Companies, Inc. All rights reserved.Fig. 4.6

20

0

30

4050

60

70

80

90

100

10

2004

1990

Non-LatinoWhite women

AfricanAmerican

women

Latinowomen

Percentage of U.S. Women Using Timely

Prenatal Care: 1990 to 2004

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Preparation for Labor & Delivery

Classes

Attitude

Plain for pain managementNatural vs Drugs

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Birth

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Three stages of birth:

Uterine contractions begin at 15 to 20minutes apart and last 1 minute; thisstage lasts an average of 12 to 24 hours.

Babys head begins to move through

dilated cervix opening; this stage lasts 1.5hour on average.

Afterbirth: umbilical cord, placenta, andother membranes are detached andexpelled.

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Birth complications include anoxia:

insufficient oxygen to brain when

delivery lasts too long.

Childbirth setting:

Hospital delivery room.

Home delivery with midwife.

Doula provides continuous

physical, emotional, and educational

support for mother before, during,

and after childbirth.

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Methods of childbirthkey choices involve

use of medication and when to have acesarean delivery.

Drugs used:

Analgesia pain relief.

Anesthesia blocks sensation. Oxytocics synthetic hormones to stimulate

contractions.

Natural childbirthaims to reduce pain by

decreasing fear and breathing techniques(Grantley Dick-Read).

Prepared childbirthLamazespecialbreathing and education about anatomy and

physiology.

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Other non-medicated techniques to

reduce pain Waterbirth

Massage

Acupuncture

Hypnosis

Music therapy

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Cesarean Delivery:

Needs to be used if baby is in breechposition or other complications.

Many today are choosing cesareandelivery.

Women in need of cesarean delivery aremore quickly identified.

Doctors may order cesarean out of

caution, and to avoid lawsuit if there is apossibility of maternal or fetal distress.

Today, 29.1 percent of all births arecesarean.

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Measuring neonatal health and responsiveness:

Apgar Scale, used 15 minutes after birth:

evaluate heart rate, body color, muscle tone,respiratory effort, and reflex irritability.

Brazelton Neonatal Behavioral Assessment Scaleperformed within 2436 hours after birth:

27 items are organized into 4 categoriesphysiological, motoric, state, and interaction.

Assesses newborns neurological development,

reflexes, and reactions to people.

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Score 0 1 2

Body ColorBlue, pale Body pink,

extremities blueEntire body pink

HeartbeatAbsent Slowless than

100 beats per min.Fast100 to 140beats per min.

Reflex

Irritability

No response Grimace Coughing,

sneezing, crying

Muscle Tone Limp and

flaccid

Inactive, weak,

some flexion of

extremities

Strong, active

motion

Respiratory

Effort

Breathing

for no more

than 1 min.

Irregular and slow Breathing good

with normal

crying

The Apgar Scale

Fig. 4.7

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Causes of low birthweight:

Preterm babies.

Small-for-date babies. Problems in developing countries.

Possible consequences of low birthweight:

Brain injuries.

Lung and liver diseases.

Learning disabilities.

ADHD. Lower levels in reading and math

achievement.

Deficits are evident in adulthood.

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About 50% of low-birthweight children

are enrolled in special education

programs.

Low birthweight is linked to asthma.

Some defects can be improved with:

Early speech therapy.

Intensive enrichment programs.

Kangaroo care and massage therapy.

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Care for preterm infants:

Kangaroo careholding preterminfant so there is always skin-to-

skin contact.

Massage therapyTiffany Fields

research.

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3 lb. 1 oz

3 lb. 7 oz

2 lb. 15 oz

3 lb. 3 oz

3 lb. 5 oz

Infant

weight 40 6 8 122 1410

Age (days)

Prematureinfants whowere massaged

Prematureinfants who

were notmassaged

Weight Gain Comparison of Premature InfantsWho Were Massaged with Those Not Massaged

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The

Postpartum

Period

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Postpartum period lasts about 6 weeks afterchildbirth when woman adjusts physically andpsychologically back to the prepregnant state:

Influenced by preceding conditions andexperiences.

Mother learns to care for the baby, feel goodabout herself, and those close to her.

Physical: hormone changes, weight loss,

return to menstruation, loss of energy orfatigue.

Psychological: feelings of depression,anxiety, coping in new role, excessiveworrying.

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Postpartum blues:symptoms appear 2 to 3

days after delivery andsubside within 1 to 2 weeks

No symptoms

10%

70%

20%

Postpartum depression: symptomslinger for weeks or months andinterfere with daily functioning

Percentage of U.S. Women WhoExperience Postpartum Bluesand Postpartum Depression

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A Fathers Adjustment:

Generally ignored, but fathers go throughconsiderable adjustment.

Some feel baby has replaced them interms of mothers affection.

Fathers should actively care for the baby.

Parents should set aside time to betogether.

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Bonding (formation of emotional

attachment) between infant andmother:

Usually occurs in period shortly after

birth.

Critical component in childs

development.

Isolation of premature baby and use of

drugs in birth process may harm bonding

process.

Some experts advocate a rooming-in

arrangement while mother and child are

in the hospital

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