Stages of Birth

1.Stage one­ process of reaching full cervical dilation

    • Latent phase­ contractions become more frequent/strong/regular
      • Cervical effacement­ thinning
      • Most variable. Up to 20hrs for 1st time, 10­12hrs 2nd time
    • If membrane ruptures, labor speeds up
  • Active phase­ most rapid cervical dilation
    • Most predictable 5hrs for 1st time, 2hrs for 2nd time
    • Deceleration Phase­ aka transition­ cervical dilation slows; fetus is lower in pelvis
    • Vomiting, uncontrollable shaking normal

 

Stage 2­ delivery of baby. Mom actively pushes

  • 2­3 hours for 1st time, shorter for 2nd
  • Episiotomy­ incision to increase vaginal opening

Stage 3­ passage of the placenta

  • Speed up thru breastfeeding; pitocin

Testing the Neonate

  • Neonate­ newborn
  • Apgar score­ 1 minutes after birth, again 5 minutes
  • 0­2
    • 1.Appearance­ skin coloration­ pink hands and feet
    • 2.Pulse­ heart rate­ above 100 BPM
    • 3.Grimace response­ to mild pinch­ pull away, cry, sneeze, cough
    • 4.Activity and muscle tone­ active, spontaneous movement
    • 5.Respiration­ breathing rate/effort­ good cry
      • Only designed to see if the baby needs immediate medical care
      • NOT predictive

Physical Appearance of Neonate

  • 1.Cone­ Shaped Head­ compressed during birth
  • 2.Vernix­ greasy, cheese­like substances
  • 3.Lanugo­ soft, downy hair, esp. on shoulders, back, forehead, and cheeks 4.Blood, ect.

Bonding­ close physical/ emotional contact between parent and neonate immediately after birth

  • NOT “now or never”
  • Needless guilt

Gentle massage­ chemicals that contribute to growth

Alternative Approaches to Childbirth

1.Lamaze­ emphasizes breathing and having a birth partner

    • Allows for epidural

2.Bradley method­ presence of partner; no use of drugs/ surgery/ tools

3.Hypnobirth­ self­hypothesis; staying focused

4.Home birth­ not recommended if diabetic/ high blood pressure/ preterm labor

5.Water delivery­ buoyancy may help relieve discomfort/pressure

Childbirth Attendants

1.Obstetrician­ doctors who specialize in delivering babies

2.Midwives­ nurses who specialize in delivering babies

Used when no complications are expected

2.Doulas­ provide emotional support; no medical background

Birth Complications

1.Preterm Infants­ less than 38 weeks gestation

    • Higher risk of illness/death­ degree largely dependent on size
    • Low birthrate­ less than 5 1/2 lbs.
    • Average is 7 1/2 lbs.
    • Small for gestational age­ smaller than average for # of weeks of pregnancy
    • Below 10th percentile
    • Respiratory distress syndrome­ difficulty breathing
    • Lack of surfactant­ slippery substance; keeps air sacs from collapsing
    • Easily overwhelmed by stimuli
    • Uncoordinated

2.Very low birthweight infants­ less than 2 1/4 lbs

    • Extremely premature. Less than 25 weeks has 50/50 chance of survival
    • Incredibly expensive
    • # increasing due to more multiple births
    • Read section on causes of Preterm and Low­ Birthweight infants
    • Postmature infants­ not yet born after 42 weeks­ 2 weeks overdue
    • Placenta ages and fail
    • Malnutrition; lack of oxygen0­ brain damage
  • May inhale fecal matter­ pneumonia
    • More difficult birth for mother

2.Cesarean delivery­ surgery to deliver baby thru incision in abdomen and uterus

    • Recommended if:
    • Pregnancy complications
    • Previous C­section

 

  • Labor not progressing
    • Baby isn’t getting enough oxygen
    • Baby is in abnormal position
    • Twins, triplets, ect.
  • Risks for mother­ comparable to any major surgery
    • Risks for infant
    • Transient Tachypnea­ abnormally fast breathing
    • Surgical injury

The Competent Newborn

1.Physical competence­ at birth neonate must make 5 adjustments

    • Breathing air
    • Eat/digest own food
  • Excrete own waste
    • Maintain body temperature
    • Adjust to intermittent feeding
  • Newborn reflexes
    • Rooting reflex
    • Sucking reflex

2.Sensory capabilities

  • Vision­ limited for first few weeks
  • 7­12 inches from face ii. Most interested in human face iii.     Need sharp contrasts
  • Limited tracking ability
  • Hearing­ fairly sensitive. Loud noises are startling.
    • Prefers familiar sounds; rhythmic sounds
    • Smell and Taste­ taste is very acute
      • Prefers sweet tastes; sour/bitter makes them cry or grimace
      • Not as much research on smell
      • Touch­ extremely important for bonding, infant’s development
      • Skin is VERY sensitive!

3. Early Learning Capabilities

    • Classical conditioning
    • Operant conditioning
  • Habituation­ decreases in response after repeated presentations of same stimulus