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Children

4. Children. Birth. What Happens During Birth?. Images of Children. Tanner Roberts’ Birth: A fantastic voyage Cindy and Tom recount the hours and changes that took place before their son, Tanner Roberts, was born and during his birth process. Contractions, pain medication

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Children

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  1. 4 Children Birth

  2. What Happens During Birth? Images of Children • Tanner Roberts’ Birth: A fantastic voyage • Cindy and Tom recount the hours and changes that took place before their son, Tanner Roberts, was born and during his birth process. • Contractions, pain medication • Delivery, breathing on his own

  3. What Happens During Birth? Stages of Birth • First stage • Lasts about 12 to 24 hours; longest stage • Contractions are about 15–20 minutes apart; occur closer together as birth nears • Contractions dilate cervix to open about 4 in. • Allows baby to move into birth canal

  4. What Happens During Birth? Stages of Birth • Second stage • Approximately 45 minutes to an hour • Baby moves through cervix and birth canal • Mother pushes down, contractions come almost every minute • Third stage (afterbirth) • Placenta, umbilical cord, and other membranes detached and expelled • Fastest stage; lasts only minutes

  5. Placenta Vagina a b Cervix Placenta Uterus c d The Stages of Birth Fig. 4.1

  6. What Happens During Birth? Childbirth Setting And Attendants • 99% of U.S. births occur in hospitals • Other options • Freestanding birth center, home delivery • Who helps during birth process varies across cultures • 91% of U.S. births attended by physicians • Some exclude fathers from process • Some attended by family members or open to community

  7. What Happens During Birth? Childbirth Setting And Attendants • Midwives • Norm in most of world • Attend 8% of U.S. births • U.S. certified nurse midwives • More time with patient in prenatal visits • More emphasis on counseling, education • Provide more emotional support to mother • Are present during entire birth process

  8. What Happens During Birth? Childbirth Setting And Attendants • Doulas • Provide continuous physical, emotional, and educational support before, during, and after childbirth • Most in U.S. work independently, typically function as part of ‘birthing team’

  9. What Happens During Birth? Methods of Childbirth • Use of medication during delivery • Analgesia is used to relievepain • Anesthesia isused in late first-stage labor and during expulsion to block sensation • Epidural block: numbs from waist down • Oxytocin • Synthetic hormones stimulate contractions

  10. What Happens During Birth? Methods of Childbirth • Natural childbirth • Tries to reduce mother’s pain by reducing fear • Prepared childbirth (Lamaze method) • Similar to natural childbirth • Special breathing technique in final stages of labor • Many other techniques have developed

  11. What Happens During Birth? Methods of Childbirth • Other methods to reduce pain and stress during labor and childbirth • Waterbirth • Massage • Acupuncture • Hypnosis • Music therapy

  12. What Happens During Birth? Methods of Childbirth • Cesarean Delivery • Baby removed from uterus through incision in abdomen when • Baby is in breech or crosswise position • Head too large for mother’s pelvis • Vaginal bleeding has occurred in pregnancy • U.S. births by C-sections increased since 2002

  13. Measures of Neonatal Health The Fetus/Newborn Transition • Anoxia occurs during contractions • Insufficient oxygen to fetus/newborn • Stress hormone secretion protects from oxygen deficiency, prepares infant for birth • Vernix caseosa (skin grease) protects against heat loss

  14. Measures of Neonatal Health Neonatal Measurements • Apgar scale • Widely used to assess health at 1 and 5 minutes after birth • Score of 7 to 10 is good, below 3 signals emergency • Identifies high-risk infants

  15. Apgar scale

  16. Measures of Neonatal Health Neonatal Measurements • Brazelton Neonatal Behavioral Assessment Scale (NBAS) • Performed within 24 to 36 hours after birth • Neurological development, reflexes • Reactions to people/objects • Infant is active participant, based on best performance • “worrisome,” “normal,” and “superior” classifications

  17. Measures of Neonatal Health Neonatal Measurements • Neonatal Intensive Care Unit Network Neurobehavioral Scale • Offspring of NBAS • Provides more comprehensive analysis of newborn behavior • Assesses ‘at risk’ or preterm infant

  18. LBW and Preterm Infant Development Preterm and Small for Date Infants • Low-birth-weight infant is under 5.5 lbs • Very low - under 3 lbs • Extremely low - under 2 lbs • Preterm – born 3 or more weeks early • Small for date – birth weight below normal • Increased use of progestin to prevent preterm births

  19. LBW and Preterm Infant Development Consequences of Preterm and LBW • As a group - more developmental and health problems • Risk increases as gestation age decreases • Norwegian study • Preterm-birth adolescents at higher risk for language delays, learning problems, and behavior problems/delinquency involvement

  20. LBW and Preterm Infant Development Nurturing Preterm Infants • Nurturing Preterm Infants • Intensive enrichment programs can improve short-term outcomes • Two most popular intervention programs • Kangaroo care– used by most NICU nurses • Massage therapy– used by 37% of NICUs • More touch promotes faster development

  21. The Postpartum Period Postpartum Period • Period after childbirth • Mother adjusts physically and psychologically to process of childbearing • Lasts about six weeks • Involution • Process by which uterus returns to pre-pregnant size

  22. The Postpartum Period Emotional and Psychological Adjustments • Emotional fluctuations due to • Hormonal changes, fatigue, inadequate rest • Inexperience or lack of confidence • Extensive demands may cause anxiety, depression, coping difficulties • Postpartum depression • Strong feelings of sadness, anxiety, despair • Gets worse without treatment

  23. The Postpartum Period Emotional and Psychological Adjustments • Postpartum depression treatments • Antidepressants • Psychotherapy; cognitive therapy is best • Postpartum depression affects • Mother-infant interaction • Risk of additional psychological disorders

  24. “Baby Blues” Symptoms appear 2 to 3 days after delivery and subside within 1 to 2 weeks Postpartum depression Symptoms linger for weeks or months and interfere with daily functioning No symptoms Percentage of U.S. women experiencing “Baby Blues” and Postpartum Depression

  25. The Postpartum Period Emotional and Psychological Adjustments • Father’s adjustment • Experiences considerable adjustment and stress • Attention for infant decreases couple’s time • Father’s postpartum reactions • Prenatal involvement can lessen feelings of depression

  26. The Postpartum Period Bonding • Close connection, especially physical bond, between parents and newborn in period shortly after birth • Encouraged by many doctors: “rooming in” • Little evidence for a critical bonding period, but parents enjoy and can be helpful • Parent-child interaction climate improved

  27. 4 The End

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