The Baby’s Arrival

Chapter 7

The Birth Process• A. The beginning of Labor

• 1. lightening – baby drops into pelvis area• 2. mucus plug of cervix exits

• a). Prevents bacteria from entering uterus• b). Mucus liquefies and exits as blood

• 3. water breaks• a). Gush of warm fluid from vagina• b). Amniotic sac is broken• c). Usually doesn’t happen until in the hospital in

active labor• d). Want to deliver within 24-48 hours of water

breaking

• 4. Contractions – tightening and releasing of uterine muscle• a). Just like any other muscle contracts,

very strong• b). Over time they get patterned – longer,

stronger, and closer together• C). Braxton-Hicks

• False contractions

Stages of Labor• A. 1st stage – contractions open the cervix

• 1. cervix dilates, widens, to about 10 cm (4 inches)• 2. cervix becomes as thin as a piece of paper –

effacement• 3. contractions 60 seconds long, 5-6 minutes apart• 4. Head drops lower in pelvis• 5. If butt, feet first = breech

• a). Dr will evaluate if vaginal birth is possible• 6. End of 1st – contractions 90 sec, 3-4 minutes apart• 7. Fully dilated

• B. 2nd Stage – baby is born• 1. head slips into vagina from uterus• 2. contractions work to move baby down, rather

than stretch cervix• 3. stage may last a few minutes or several hours• 4. culminates into birth of baby• 5. ligaments stretch like rubber bands so baby

can fit through bones of pelvis• 6. hormones make ligaments and vagina

stretchy

• 7. baby’s skull is soft and flexible, bones overlap each other so they can fit

• 8. episiotomy – cut opening of vagina so baby can fit through – sometimes this happens without cutting – results in tearing which can cause complications after recovery

• 9. forceps – guide baby’s head out• 10. vacuum – “sucks” baby out by attaching

it to head of baby

• C. 3rd Stage – placenta is expelled• 1. uterus gives birth to placenta• 2. 2-30 minutes

Cesarean Birth

• A. needed if there is complications• 1. breech• 2. complications during pregnancy• 3. has had a C-section before• 4. V-back = have vaginal birth after a c-

section• 5. usually stay 4 days after birth• 6. may be awake during procedure

The Newborn at Birth• A. Lungs

• 1. fluid is squeezed out of them during the birthing process as it goes through canal

• 2. pressure releases and baby’s lungs expand = 1st breath = cry

• 3. fluid suctioned out• 4. if need help to keep breathing –

nurse will rub baby’s back

• B. Heart• 1. once lungs take in air, CS changes• 2. valve in the heart closes and over the

next few days become permanently sealed• 3. blood now circulates through lungs rather

than bypassing them• 4. umbilical cord stops pulsing, shrinks

minutes after birth and is clamped, tied, and cut off

• C. How does a newborn look?• 1. head is wobbly and large

• A. accounts for ¼ of baby’s length

• 2. may be lopsided from going through canal

• 3. soft spots – fontanels – skull hasn’t joined together to allow for movement

• 4. 6-18 months grow together• 5. very tough skin on top to protect brain

until the bones grow together

• 6. fat cheeks• 7. short, flat nose• 8. receding chin• ** the above make it easier for baby to

suck b/c nose and chin are out of the way

• 9. baby’s eyes are nearly adult size• 10. eyes dark-grayish blue at birth –

permanent color apparent within several months

• 11. skin – grayish – changes as baby’s CS starts working

• 12. born early – hair on back, shoulder, forehead – goes away as baby grows

• 13. vernix – rich, creamy substance to protect skin• Some is still present after birth – white• Can wash off with warm water

• 14. milia – white bumps, baby acne• Plugged oil ducts from maternal hormones• Disappears in a week or two

The Postnatal Period• A. Apgar scale – a method of evaluating a

newborn’s physical condition• Appearance, pulse, grimace, activity,

respiration• 1. Gives a rating from 0-2 in each of these 5

areas:• A. pulse• B. breathing• C. muscle tone• D. reflex to stimulation• E. skin color

• Score of 6-10 is normal• Anything less needs special medical

attention• Apgar is given 1 minute after birth and

then again at 5 minutes• Baby is also given a brief exam to

check for any conditions that might require speical care

• Within 60 minutes of delivery, drops of silver nitrate or an antiseptic ointment are put into the baby’s eyes to guard against infection

• Baby is weighed, measured, cleaned up• Permanent copy of footprints is made for

public record• 2 bands giving baby’s family name are

clamped to ankle or wrist

• Mother wears same bracelet

• Need identification to leave room later

• Heart rate • 0 – absent

• 1 – under 100

• 2 – over 100

• breathing • 0 – absent

• 1 – slow, irregular

• 2 – good, crying

• Muscle tone • 0 – limp

• 1 – some movement

• 2 – active motion

• Responsiveness• When nose irritated

• 0 – no response

• 1 – grimace, distortion of face expressing pain

• 2 – cough or sneeze

• color • 0 – blue or pale

• 1 – body limbs pink, not blue

• 2 – completely pink

Bonding and Attachment• Bonding – the process of forming lifelong

emotional ties• Delay cutting umbilical cord, cleaning, and

giving eyedrops so that parents have the opportunity to begin bonding right away

• Placed in mother’s arms or on stomach to feel skin, hear heartbeat and mother’s familiar voice

• Newborn focuses on mother’s face

• Breast feed within minutes of birth

• Baby knows instinctively what to do

• Colostrum – the first breast milk• Easy for newborn to digest• Rich in mother’s antibodies• Yellowish or clear, thick

The Hospital Stay• Monitor mother and baby very close as

both have gone through drastic changes• Mother

• Pulse, BP, and other vital signs until all body functions have stabilized

• Stay for 12 hours – bath, eat, rest, medically checked

• Or 2-3 days to recuperate

Rooming - in• Rooming-in program

• Arrangement in which the baby stays in the mother’s room, rather than in a hospital nursery, after birth

• Natural beginning to family and bonding• Homelike atmosphere where visitors can hold

baby• Set a schedule• Practice caring for baby before going home• Babies seem more content

• Birth certificate• free of charge soon after baby is born• Parents fill out a form, temporary certificate

is given• Most important piece of identification

Postnatal care of mother

• Physical needs• Rest

• Sleep whenever baby does• Get help to come so mother can sleep

• Exercise• Simple stretches• Helps return to normal figure and posture

• Nutrition• Breast feeding – very important to eat correct

amount of recommended servings• Eat right to regain energy• Drink plenty of water

• Medical checkup• 4-6 weeks after birth• Dr checks if uterus is returning to normal size• Mother can discuss any questions or concerns

about parenthood or birth control

• Emotional needs• “baby blues”

• Few days of mild depression due to hormonal changes

• Loneliness, resentment

• Make time for just eachother together

Caring for premature babies• Weigh less than 5 ½ lbs• Born before 36 weeks• Incubator – special enclosed crib in which the

O2 supply, temperature, and humidity can be closely controlled• Baby’s body is not yet ready for heat regulation,

sucking, breathing, swallowing• Baby’s heart and lungs are electronically

monitored• Special meds to combat infection• Many less than 1 lb now are able to live

• Can’t leave hospital until the baby can control his/her body temp and gain weight at the same time

• Detected early, the process can be stopped/prolonged

Journal

• What do you fear in taking care of a newborn?

• What do you have questions about?

• What do you not know how to do?

A new family member• The AMAZING newborn

• Born with remarkable capabilities• Focus their eyes, hear, smell, vocalize to

communicate• Selectively respond to human voice• Breathe independently• Cry for needs• Prefer human faces to other shapes• Can follow an object

reflexes

• Reflex – instinctive, automatic responses, such as sneezing and yawning

• Coordinated behavior helps the baby function

• Some are temporary, some continue throughout life

Types of reflexes

• 1. rooting• When touched on lips or cheek, the baby

will turn toward the touch and begin to suck• Helps baby find food• Around 4 months this reflex stops – use

eyes and become aware of surroundings

• 2. grasp• Response of a newborn’s hand to close

over anything that comes into contact with the palm

• 3 months baby’s start to reach for object• Disappears by age of 1

• 3. startle• Response to a loud noise or touch on the

stomach• Legs thrown up, fingers spread, arms

extended, then bring back to midline with clenched fists

• Lasts about 5 months

Learning to care for newborn

• What do babies need• Food

• Get to them right away so they learn to trust those around them

• Sleep• Sleep throughout the day• Wake up 1-3 times/night to feed• Average of 15/day

• Exercise• Helps develop muscle tone and nervous

system• Splashing during bath• Kicking while diaper changing

• Kept safe, clean, and warm• Make your house baby safe

• Medical care• Periodic check-ups• Check if developing normal• Immunizations

• Need things to look at, touch, listen to, and play with

• Need to be stimulated to learn

• Love• Close contact • touched

What do parents need• Knowledge to care for infant• Resources for any ?’s• Time• Emotional support• Financial planning• Reassurance and confidence• Agreement about responsibilities• Personal health/rest• Privacy, time alone

Adjusting to new routines

• Trial and error

• Cannot spoil too much in the first months

• Make a routine, schedule• Good for babies and kids to know what to

expect

Understanding the Baby’s language

• Hunger is usually the reason they cry

• Fatigue, loneliness, uncomfortable

• Average is 1 hr/day

• Recognize different cries

Journal

• What was your temperament as a child?

• Assignment – ask your mom or dad what you were like as an infant.

Early Temperament

• Temperament – style of reacting to the world and of relating to others

• Baby will have own style to reacting to situations and their personality