Child chapter 2.4

Birth & the NeonateBirth & the Neonate

2.42.4

ChildrenChildren

2

Birthing Methods & Delivery Birthing Methods & Delivery OptionsOptions

99% of U.S. births in hospitals99% of U.S. births in hospitals Other optionsOther options

– Freestanding birth centerFreestanding birth center– Home deliveryHome delivery

What Happens During Birth?

Who helps varies across culturesWho helps varies across cultures– 91% U.S. births physicians91% U.S. births physicians– Some exclude fathers Some exclude fathers – Some family members Some family members – Open to communityOpen to community



Midwives Midwives – Norm, most of worldNorm, most of world– U.S. Attend 8% birthsU.S. Attend 8% births– U.S. certified nurse midwives U.S. certified nurse midwives

Deliver babiesDeliver babies– More time with patient in prenatal visitsMore time with patient in prenatal visits– Counseling, educationCounseling, education– Emotional supportEmotional support



DoulasDoulas– No medical care No medical care

Do not deliver babiesDo not deliver babies

– Support before, during, & after childbirth Support before, during, & after childbirth PhysicalPhysical

EmotionalEmotional

EducationalEducational

– Most in U.S. work independently, typically Most in U.S. work independently, typically function as part of ‘birthing team’function as part of ‘birthing team’



Natural childbirthNatural childbirth– Goal: reduce pain by reducing fearGoal: reduce pain by reducing fear

EducationEducation

Breathing techniquesBreathing techniques

Relaxation techniquesRelaxation techniques

Prepared childbirth (Lamaze method)Prepared childbirth (Lamaze method)– Similar to natural childbirthSimilar to natural childbirth

– Special breathing technique in final stages of Special breathing technique in final stages of laborlabor



Other methods to reduce pain & Other methods to reduce pain & stress during labor & childbirthstress during labor & childbirth

– WaterbirthWaterbirth

– MassageMassage

– AcupunctureAcupuncture

– HypnosisHypnosis

– Music therapyMusic therapy


Stages of BirthStages of Birth

3 stages of birth3 stages of birth– Stage 1Stage 1

@ 12 - 24 hrs. @ 12 - 24 hrs.

– Stage 2Stage 2 @ 45 min’s - 1 hour@ 45 min’s - 1 hour

– Stage 3Stage 3 Lasts only minutesLasts only minutes

Effacement of the CervixEffacement of the Cervix

BecomesBecomes–ThinnerThinner–ShorterShorter

StartsStarts–Couple weeks before Couple weeks before deliverydelivery


11st st stage: Dilation & Effacement of the stage: Dilation & Effacement of the CervixCervix

– @ @ 12 - 24 12 - 24 hrs.hrs. Longest stageLongest stage

– Contractions @ Contractions @ 1515––20 min’s 20 min’s apartapart Closer together as birth nearsCloser together as birth nears

– Contractions dilate cervix to open @ Contractions dilate cervix to open @ 4 4 inchesinches.. Allows baby to move into birth canalAllows baby to move into birth canal



22ndnd stage : Delivery of the stage : Delivery of the

BabyBaby– @ @ 45 min’s - 1 hour45 min’s - 1 hour– Begins when:Begins when:

baby’s head moves through cervix & birth canal baby’s head moves through cervix & birth canal

– Ends when:Ends when: baby completely emergesbaby completely emerges

– Mother pushes down, contractions come @ Mother pushes down, contractions come @ every minuteevery minute


33rd rd stage: Placenta (afterbirth)stage: Placenta (afterbirth)– Placenta, umbilical cord, & other Placenta, umbilical cord, & other

membranes detached & expelledmembranes detached & expelled– Fastest stageFastest stage

minutesminutes


Cesarean SectionCesarean Section

Cesarean DeliveryCesarean Delivery– Baby removed from uterus through Baby removed from uterus through

incision in abdomen whenincision in abdomen when Baby is in breech or crosswise positionBaby is in breech or crosswise position Head too large for mother’s pelvisHead too large for mother’s pelvis Vaginal bleeding has occurred in pregnancyVaginal bleeding has occurred in pregnancy

– U.S. births by C-sections increased since U.S. births by C-sections increased since 20022002

– http://www.youtube.com/watch?v=vjgxKcjnimY


NEWBORN ASSESSMENTNEWBORN ASSESSMENT

PRETERM, LOW BIRTH PRETERM, LOW BIRTH WEIGHT, SMALL-FOR WEIGHT, SMALL-FOR DATEDATE

Preterm & Small-for-Date Preterm & Small-for-Date InfantsInfants

Low-birth-weight infant under 5.5 lbsLow-birth-weight infant under 5.5 lbs

– Very lowVery low - under 3 lbs - under 3 lbs

– Extremely lowExtremely low - under 2 lbs - under 2 lbs

PretermPreterm

– Born 3 or more weeks earlyBorn 3 or more weeks early

Small for dateSmall for date

– May be May be preterm/full termpreterm/full term

– Birth weight below normalBirth weight below normal Increased use of Increased use of progestinprogestin to to prevent preterm birthsprevent preterm births

– Lowered preterm births 1/3Lowered preterm births 1/3



Consequences of preterm & LBWConsequences of preterm & LBW Most low birth weight infants Most low birth weight infants

– normal & healthynormal & healthy As a groupAs a group

– More developmental & health problemsMore developmental & health problems– Risk increases as gestation age decreasesRisk increases as gestation age decreases Potential problems includePotential problems include

brain injuriesbrain injuries lung & liver diseaseslung & liver diseases learning disabilitieslearning disabilities breathing problemsbreathing problems

Norwegian studyNorwegian study– Preterm-birth adolescents higher risk Preterm-birth adolescents higher risk

for:for: language delayslanguage delays learning problemslearning problems behavior problems/delinquency involvementbehavior problems/delinquency involvement

Consequences of Preterm & Consequences of Preterm & LBWLBW

INFANT CAREINFANT CARE2.52.5

BondingBonding Close connection, especially physical Close connection, especially physical

bond, between parents & newborn in bond, between parents & newborn in period shortly after birthperiod shortly after birth

– Doctors suggest: Doctors suggest: ““rooming in”rooming in”

– Newborn kept in mother's hospital Newborn kept in mother's hospital room

Immediate bonding Immediate bonding

– Not Not necessary for emotional healthnecessary for emotional health Adoption?Adoption?

The Postpartum Period

Postpartum DepressionPostpartum Depression

Period after childbirth Period after childbirth – Mother adjusts physically & psychologically to Mother adjusts physically & psychologically to

process of childbearingprocess of childbearing

– Lasts about @ 6 weeksLasts about @ 6 weeks

Involution Involution – Process by which uterus returns to pre-Process by which uterus returns to pre-

pregnant sizepregnant size

– 5 - 6 weeks 5 - 6 weeks


8. Postpartum Period8. Postpartum Period

Postpartum DepressionPostpartum Depression

Emotional & Psychological Emotional & Psychological AdjustmentsAdjustments

– Emotional fluctuations due to:Emotional fluctuations due to: Hormonal changesHormonal changes

FatigueFatigue

Inadequate restInadequate rest

Inexperience or lack of confidenceInexperience or lack of confidence

Extensive demands may causeExtensive demands may cause– Anxiety, depression, coping difficultiesAnxiety, depression, coping difficulties


Emotional & Psychological Emotional & Psychological AdjustmentsAdjustments

Postpartum depressionPostpartum depression– Strong feelings ofStrong feelings of

SadnessSadness AnxietyAnxiety DespairDespair

– Gets worse without treatmentGets worse without treatment

Emotional and Psychological Emotional and Psychological AdjustmentsAdjustments

Postpartum depression treatmentsPostpartum depression treatments

– AntidepressantsAntidepressants

– Psychotherapy; cognitive therapy is bestPsychotherapy; cognitive therapy is best

Postpartum depression affectsPostpartum depression affects

– Mother-infant interactionMother-infant interaction

– Risk of additional psychological Risk of additional psychological disordersdisorders


Emotional and Psychological Emotional and Psychological AdjustmentsAdjustments

Father’s adjustmentFather’s adjustment– Considerable adjustment & stress Considerable adjustment & stress

Attention on infant decreases couple’s timeAttention on infant decreases couple’s time May feel unneededMay feel unneeded

– Father’s postpartum reactionsFather’s postpartum reactions Prenatal involvement can lessen feelings of Prenatal involvement can lessen feelings of

depressiondepression


Infant Nutrition & HealthInfant Nutrition & Health

• Infants in 1 yr. Infants in 1 yr. Triple weightTriple weight

– Increase length 50% Increase length 50% – 50 calories per day 50 calories per day

per lb. of weightper lb. of weight– High-calorie, high-High-calorie, high-

energy foods & fats energy foods & fats very importantvery important NO NONFAT FOODSNO NONFAT FOODS

Infant Nutrition & HealthInfant Nutrition & Health

Healthy infants need:Healthy infants need:– Loving, supportive feeding environmentLoving, supportive feeding environment– Breast milk Breast milk – Gradual increase of chew-&-swallowGradual increase of chew-&-swallow– More fruits & vegetables, less junk foodMore fruits & vegetables, less junk food– Demand feeding becoming more Demand feeding becoming more

popularpopular– Poor dietary patterns can cause Poor dietary patterns can cause

overweightoverweight

Co-sleepingCo-sleeping

Culture and Sleeping ArrangementsCulture and Sleeping Arrangements

– Sharing bed common in many culturesSharing bed common in many cultures

– American Academy of PediatricsAmerican Academy of Pediatrics– Discourages co-sleeping because ofDiscourages co-sleeping because of

StressStressSIDS riskSIDS risk

How Do Infants Grow and Develop Physically?

Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)

Infant stops breathing, usually during Infant stops breathing, usually during night, and dies without apparent night, and dies without apparent causecause– Highest cause of infant death in U.S.Highest cause of infant death in U.S.– Highest risk is 2 - 4 mo.'s of ageHighest risk is 2 - 4 mo.'s of age– Sleeping on back reduces riskSleeping on back reduces risk– Less common in:Less common in:– bedroom with fanbedroom with fan– infant who sleeps with pacifierinfant who sleeps with pacifier



Thoughts?Thoughts?


Highest risksHighest risks– Lower birth weightLower birth weight– Siblings with SIDSSiblings with SIDS– Sleep apnea Sleep apnea – Lower SES groupsLower SES groups– Exposure to cigarette smokeExposure to cigarette smoke– Placement in soft beddingPlacement in soft bedding– Abnormal brain stem functioningAbnormal brain stem functioning– African American & Inuit infants African American & Inuit infants


Breast Versus Bottle Breast Versus Bottle FeedingFeeding

Breast milk Breast milk – Fewer gastrointestinal infectionsFewer gastrointestinal infections– Lower respiratory tract infectionsLower respiratory tract infections– Reduces effects of asthma in first 3 mo’sReduces effects of asthma in first 3 mo’s– Reduce risk of skin inflammation Reduce risk of skin inflammation – May lessen likelihood of obesityMay lessen likelihood of obesity– Lowers risk of childhood & adult diabetesLowers risk of childhood & adult diabetes– Less risk of experiencing SIDSLess risk of experiencing SIDS– Claims of no link to allergy preventionClaims of no link to allergy prevention


Malnutrition in InfancyMalnutrition in Infancy

Early weaning can Early weaning can cause deficienciescause deficiencies

Can develop:Can develop:– MarasmusMarasmus– Wasting away of Wasting away of

body tissues body tissues infant’s 1infant’s 1stst yr. yr.


Malnutrition in InfancyMalnutrition in Infancy

KwashiorkorKwashiorkor Deficiency in proteinDeficiency in protein Abdomen, feetAbdomen, feet swollen with waterswollen with water If not fatal, effects If not fatal, effects

detrimentaldetrimental Lowest SESLowest SES Aided by Aided by

supplementary supplementary feedingfeeding

Nonorganic Failure to ThriveNonorganic Failure to Thrive

Child may die Child may die Occurs before 18 mo.'s.Occurs before 18 mo.'s. Denied Denied

– AffectionAffection– Emotional SupportEmotional Support– StimulationStimulation

Harry Harlow experimentHarry Harlow experiment

Child chapter 2.4

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Transcript of Child chapter 2.4