How Does a Baby Help With Its Own Birth

Chapter 3: Birth and the Newborn

Jennifer Paris; Antoinette Ricardo; and Dawn Rymond

Afterwards this chapter, you lot should be able to:

1. Compare and contrast different methods of childbirth preparation.
2. Depict the stages of vaginal delivery.
3. Explain why induction or Caesarean section may be necessary.
4. Differentiate the common procedures for assessing the condition of the newborn.
5. Examine issues newborns experience before, during, and later on birth.

Introduction

Later on around 266 days of developing within the womb (for a full-term pregnancy), comes the backbreaking process of childbirth. After birth, newborns have to regulate their ain trunk temperature, exhale for themselves, and accept in all of their nutrition through feeding. Allow'south look at both the procedure of birth and some attributes of the newborn.

Preparing for Childbirth

Prepared childbirth refers to being not only in expert concrete condition to help provide a healthy environment for the babe to develop, but too helping individuals to prepare to take their new roles equally parents. Additionally, parents tin receive information and grooming that will assist them for delivery and life with the baby. The more future parents tin can learn well-nigh childbirth and the newborn, the improve prepared they volition exist for the adjustment they must make to a new life.

Approaches to Childbirth

There are many dissimilar approaches to childbirth that influence how expectant parents prepare. The following tabular array describes a few of these:

Table iii.i – Approaches to Childbirth ^[i]

Method	Clarification
The Lamaze Method	The emphasis of this method is on teaching the woman to exist in control in the process of commitment. It includes learning musculus relaxation, breathing through contractions, having a focal point (unremarkably a picture to look at) during contractions and having a support person who goes through the grooming process with the mother and serves every bit a passenger vehicle during delivery.
The Leboyer Method	This method involves giving nascency in a serenity, dimly lit room and allowing the newborn to prevarication on the mother'southward tummy with the umbilical cord intact for several minutes while existence given a warm bath.
Dick-Read Method / Mongan Method / Hypnobirthing	This method comes from the suggestion that the fearfulness of childbirth increases tension and makes the process of childbearing more than painful. It emphasizes the use of relaxation and proper animate with contractions besides equally family unit support and teaching.
Bradley Method	"The Bradley Method focuses on preparing the mother for a natural childbirth coached by her partner. They larn techniques to reduce the perception of pain and stay relaxed. The accent is on being prepared for an unassisted vaginal birth without medication."[2]
Alexander Technique	This is a technique that tin can exist used during childbirth that involves training to finish habitual reactions to pain, such as tensing muscles and increase conscious sensation and command over posture and movement. This involves being able to move freely and stay upright during labor and using trunk positioning that is beneficial to the labor process.[3]
Waterbirth	Involves immersion in warm water. Proponents believe this method is safe and provides many benefits for both mother and infant, including hurting relief and a less traumatic birth experience for the baby. Nonetheless, critics argue that the procedure introduces unnecessary risks to the infant such as infection and water inhalation.[iv]
Lotus Birth	Or umbilical string nonseverance – UCNS, is the practice of leaving the umbilical cord uncut after childbirth then that the baby is left attached to the placenta until the cord naturally separates at the omphalos. This usually occurs inside three–10 days later nascence. The practice is performed mainly for spiritual purposes of the parents, including for the perceived spiritual connection between placenta and newborn.[5]
Silent Birth	Sometimes known as repose birth, is a birthing procedure brash by L. Ron Hubbard and advocated by Scientologists in which "everyone attention the nascence should refrain from spoken words as much as possible."[half-dozen]
Medicated Childbirth	Health care providers tin can provide pain relief during labor with different types of medication, including epidurals, spinal blocks, combined spinal-epidurals, and systemic and local analgesia. There are benefits and side effects of each.[7]

Figure 3.1 – Expectant parents in a childbirth training grade.^[8]

Choosing Location of Childbirth & Who Will Deliver

The vast bulk of births occur in a hospital setting. However, one percent of women choose to deliver at dwelling (Martin, Hamilton, Osterman, Curtin, & Mathews, 2015). Women who are at low gamble for nascency complications tin can successfully deliver at home. More than than half (67%) of home deliveries are by certified nurse midwives. Midwives are trained and licensed to aid in commitment and are far less expensive than the price of a hospital commitment. However, because of the potential for a complexity during the birth process, well-nigh medical professionals recommend that delivery accept place in a hospital. In addition to habitation births, one-third of out-of-infirmary

births occur in freestanding clinics, birthing centers, in medico'south offices, or other locations.^[9]

Childbirth

Onset of Labor

Childbirth typically occurs within a week of a adult female'southward due date, unless the woman is pregnant with more than than ane fetus, which ordinarily causes her to go into labor early. Every bit a pregnancy progresses into its final weeks, several physiological changes occur in response to hormones that trigger labor.

A common sign that labor is get-go is the so-called "bloody bear witness." During pregnancy, a plug of mucus accumulates in the cervical canal, blocking the archway to the uterus. Approximately ane–ii days prior to the onset of true labor, this plug loosens and is expelled, along with a modest amount of blood.

As labor nears, the mothers' pituitary gland produces oxytocin. This begins to stimulate stronger, more than painful uterine contractions, which—in a positive feedback loop—stimulate the secretion of prostaglandins from fetal membranes. Similar oxytocin, prostaglandins also enhance uterine contractile strength. The fetal pituitary gland also secretes oxytocin, which increases prostaglandins even further.

And the stretching of the cervix past a full-term fetus in the head-down position is regarded as a stimulant to uterine contractions. Combined, these stimulate true labor.^[ten]

Stages of Birth for Vaginal Delivery

The Outset Stage

Uterine contractions signify that the first stage of labor has begun. These contractions may initially last most thirty seconds and be spaced 15 to 20 minutes apart. These increase in elapsing and frequency to more than a infinitesimal in length and about 3 to iv minutes autonomously. Typically, doctors propose that they be called when contractions are coming nearly every 5 minutes. Some women feel simulated labor or Braxton-Hicks Contractions, particularly with the first child.

These may come and go. They tend to diminish when the mother begins walking around. Real labor pains tend to increment with walking. In one out of eight pregnancies, the amniotic sac or h2o in which the fetus is suspended may break before labor begins. In such cases, the physician may induce labor with the utilize of medication if it does not begin on its ain in order to reduce the chance of infection. Normally this sac does not rupture until the later stages of labor.

The kickoff stage of labor is typically the longest. During this stage the cervix or opening to the uterus dilates to 10 centimeters or just under 4 inches. This may have effectually 12-16 hours for first children or well-nigh 6-9 hours for women who have previously given nascency. Labor may besides begin with a discharge of blood or amniotic fluid.

Figure 3.2 – Early cervical dilation. ^[eleven]

The Second Stage

The passage of the baby through the nativity canal is the second phase of labor. This stage takes about x-40 minutes. Contractions usually come virtually every 2-three minutes. The mother pushes and relaxes as directed by the medical staff. Normally the head is delivered first. The baby is and then rotated then that one shoulder can come through and and so the other shoulder. The residue of the baby quickly passes through. At this stage, an episiotomy, or incision made in the tissue between the vaginal opening and anus, may be performed to avoid tearing the tissue of the back of the vaginal opening (Mayo Clinic, 2016). The baby's mouth and nose are suctioned out. The umbilical cord is clamped and cut.^[12]

Effigy 3.3 – Total dilation and expulsion of the newborn.^[thirteen]

The Third Stage

The third and final phase of labor is relatively painless. During this stage, the placenta or afterbirth is delivered. This is typically inside 20 minutes later delivery. If an episiotomy was performed information technology is stitched up during this stage.^[14]

Effigy 3.4 – Delivery of the placenta and associated fetal membranes.^[xv]

Boosted Considerations

More than than 50% of women giving nascence at hospitals use an epidural anesthesia during commitment (American Pregnancy Association, 2015). An epidural cake is a regional analgesic that can be used during labor and alleviates most pain in the lower body without slowing labor. The epidural block tin exist used throughout labor and has trivial to no effect on the baby. Medication is injected into a small space exterior the spinal cord in the lower dorsum. It takes ten to twenty minutes for the medication to take effect. An epidural block with stronger medications, such as anesthetics, tin be used shortly before a Cesarean Section or if a vaginal nascency requires the utilize of forceps or vacuum extraction.^[16]

Women giving nativity can likewise receive other pain medications (although medications given through injection can have negative side effects on the baby). In emergency situations (such every bit the need for a C-section), women may exist given full general anesthesia. They can also cull not to utilise whatever pain medications. That is often referred to as natural childbirth.

Figure iii.v – Natural childbirth.^[17]

Women can also utilise alternating positions (including standing, squatting, being on hands and knees, and using a birthing stool) and laboring, and even delivering in tubs of warm h2o to assistance salvage the pain of childbirth.

Medical Interventions in Childbirth

Sometimes women cannot go into labor on their own and/or deliver vaginally. Let'south look at induction of labor and Cesarean Sections.

Sometimes a baby's arrival may need to be induced before labor begins naturally. Induction of labor may be recommended for a diverseness of reasons when in that location is concern for the wellness of the mother or infant. For example:

• The mother is approaching 2 weeks beyond her due engagement and labor has non started naturally
• The mother's water has cleaved, but contractions have non begun
• There is an infection in the mother'due south uterus
• The infant has stopped growing at the expected pace
• There is not enough amniotic fluid surrounding the baby
• The placenta peels abroad, either partially or completely, from the inner wall of the uterus earlier delivery
• The mother has a medical condition that might put her or her baby at adventure, such as high blood pressure or diabetes (Mayo Clinic, 2014).

A Cesarean Department (C-section) is surgery to evangelize the baby past being removed through the female parent'southward abdomen. In the United States, about i in three women have their babies delivered this way (Martin et al., 2015). Most C-sections are done when problems occur during commitment unexpectedly. These tin include:

• Health problems in the mother
• Signs of distress in the babe
• Not enough room for the baby to become through the vagina
• The position of the baby, such as a breech presentation where the head is not in the downward position.

Effigy 3.6 – A woman receiving a C-section.[18]	Effigy three.7 – A baby being delivered by C-section.[xix]

C-sections are besides more than common among women carrying more than one baby. Although the surgery is relatively safe for mother and baby, it is considered major surgery and carries wellness risks. Additionally, it besides takes longer to recover from a C-department than from vaginal birth. Afterward healing, the incision may leave a weak spot in the wall of the uterus. This could cause problems with an attempted vaginal birth after. In the by, doctors were hesitant to let a vaginal birth afterwards a C-section. However, now more than one-half of women who have a C-section go on to have a vaginal birth later.^[20] This is referred to as a Vaginal Birth Subsequently Cesarean (VBAC).

The Newborn

Figure 3.8 – A new mother holding her newborn.^[21]

Assessing the Newborn

The Apgar assessment is conducted one infinitesimal and 5 minutes after birth. This is a very quick style to assess the newborn's overall status. 5 measures are assessed: Center rate, respiration, muscle tone (assessed by touching the baby'due south palm), reflex response (the Babinski reflex is tested), and colour. A score of 0 to 2 is given on each feature examined. An Apgar of v or less is cause for business organization. The 2nd Apgar should indicate improvement with a higher score.^[22]

Figure 3.ix – The Apgar cess.^[23]

Some other way to assess the condition of the newborn is the Neonatal Behavioral Assessment Scale (NBAS). The baby's motor development, muscle tone, and stress response are assessed. This tool has been used around the world to further appraise the newborn, peculiarly those with low Apgar scores, and to brand comparisons of infants in different cultures (Brazelton & Nugent, 1995).

Newborns are also routinely screened for unlike atmospheric condition. Within the first 24 to 48 hours after birth, babies born in hospitals undergo a simple heel stick and a few drops of blood are collected on a special paper bill of fare. Providers test those dried blood spots for a variety of unlike built disorders, or conditions that are present when the babe is born. In California, newborns are now screened for lxxx different genetic and congenital disorders.

Figure 3.10 – A medical professional performing the heel stick exam.^[24]

Newborns are also screened for hearing disorders and certain serious heart problems using methods other than dried blood spots.^[25]

Problems of the Newborn

Anoxia

Anoxia is a temporary lack of oxygen to the brain. Difficulty during delivery may lead to anoxia which can event in encephalon damage or in severe cases, death. Babies who suffer both low nascency weight and anoxia are more than likely to suffer learning disabilities subsequently in life every bit well.

Low Birth Weight

A child is considered low birth weight if he or she weighs less than five pounds 8 ounces (2500 grams). About eight.2 per centum of babies built-in in the United States are of depression nascence weight (Center for Affliction Command, 2015a). Sixty-seven per centum of these babies are also preterm.

A depression birth weight baby has difficulty maintaining adequate body temperature because it lacks the fat that would otherwise provide insulation. Such a baby is as well at more risk for infection. Very low birth weight babies (2 pounds or less) have an increased adventure of developing cerebral palsy. Many causes of low birth weight are preventable with proper prenatal care.

Preterm

A newborn might also accept a depression birth weight if it is born at less than 37 weeks gestation, which qualifies it equally a preterm baby (CDC, 2015c). Early birth can exist triggered by anything that disrupts the mother'south system. For example, vaginal infections tin can lead to premature nascence considering such infection causes the mother to release anti-inflammatory chemicals which, in turn, can trigger contractions. Smoking and the use of other teratogens can lead to preterm nascency. A meaning consequence of preterm birth includes respiratory distress syndrome, which is characterized by weak and irregular breathing (run into the image below). Premature babies often cannot yet regulate their own temperature or feed by nursing or bottle. They may struggle to regulate their heart rate effectively and may experience jaundice. They often require care in the Neonatal Intensive Care Unit (NICU) until they are as healthy as a total-term babe.

Effigy three.xi – A premature baby on CPAP in the NICU.^[26]

Small-for-Date Infants

Infants that have birth weights that are below expectation based on their gestational age are referred to equally minor-for-engagement. These infants may exist full term or preterm (see image below), but notwithstanding weigh less than 90% of all babies of the same gestational historic period. This is a very serious state of affairs for newborns every bit their growth was adversely affected. Regev et al. (2003) found that minor-for- date infants died at rates more than four times college than other infants.

Figure iii.12 – This baby was built-in at 32 weeks and just weighed 2 pounds and 15 ounces.^[27]

Postmature

When babies are not born by 42 weeks gestation, or two weeks after their due appointment, they are considered overdue or postmature. At that place are some concerns well-nigh how long the placenta can office and most doctors volition consider consecration for overdue babies.

Stillborn

When a fetus (unborn baby) dies while notwithstanding within the mother (later 20-24 weeks gestation) or dies during delivery (childbirth). It is said that the delivered baby is stillborn. The causes of many stillbirths are unknown, even when special tests are done to learn the crusade. Possible causes include: nicotine, alcohol, or drugs taken by the female parent during pregnancy, physical trauma, radiation poisoning, Rh affliction, and umbilical cord issues. The number of stillbirths in the United States is about 1 in 115 births, which is virtually 26,000 a yr, or 1 every 20 minutes.^[28]

Characteristics of Newborns

Size

The boilerplate newborn in the United States weighs near seven.five pounds and is almost 20 inches in length. For the offset few days of life, infants typically lose about five percent of their body weight as they eliminate waste material and get used to feeding. This oftentimes goes unnoticed past nigh parents, but tin be cause for concern for those who have a smaller infant. This weight loss is temporary, nonetheless, and is followed by a rapid flow of growth.

Effigy 3.13 – A newborn being weighed.^[29]

Torso Proportions

The head initially makes up nigh 50 per centum of our entire length when nosotros are developing in the womb. At birth, the head makes upward near 25 percent of our length (think nearly how much of your length would exist head if the proportions were nonetheless the same!).

Figure 3.fourteen – Body proportions from infancy to adulthood.^[thirty]

Brain Development

Some of the nigh dramatic concrete modify that occurs during this period is in the brain. At nascence, the brain is about 25 percentage its adult weight and this is not true for whatsoever other part of the body. While most of the brain'southward 100 to 200 billion neurons are nowadays at nativity, they are not fully mature. During the adjacent several years dendrites or connections betwixt neurons will undergo a period of transient exuberance or temporary dramatic growth.^[31]

Advent at Nascence

During labor and birth, the babe's skull changes shape to fit through the birth culvert, sometimes causing the child to be born with a misshapen or elongated caput. It will usually return to normal on its ain within a few days or weeks.

Some newborns have a fine, downy body pilus called lanugo. It may exist particularly noticeable on the back, shoulders, brow, ears and face of premature infants. Lanugo disappears inside a few weeks. Likewise, not all infants are built-in with lush heads of hair. Some may be nearly bald while others may take very fine, almost invisible hair. Some babies are even born with a full head of hair. Amongst fair-skinned parents, this fine hair may be blond, even if the parents are not. The pic on the left shows lanugo on the shoulders of newborn twins.

Immediately afterwards birth, a newborn's peel is oft grayish to dusky bluish in color. As soon equally the newborn begins to breathe, ordinarily within a minute or two, the skin'due south colour returns to its normal tone. Newborns are wet, covered in streaks of blood, and coated with a white substance known equally vernix, which is thought to act as an antibacterial barrier, seen in the picture on the right.

The scalp may likewise exist temporarily hobbling or swollen, especially in hairless newborns, and the expanse effectually the eyes may exist puffy.

The newborn may also have Mongolian spots (blue or blue blackness birthmark on the lower back), various other birthmarks, or peeling skin, especially on the wrists, hands, ankles, and feet. ^[34]

A newborn's genitals are enlarged and reddened, with male infants having an unusually big scrotum. The breasts may also be enlarged, even in male infants. This is caused by naturally- occurring maternal hormones and is a temporary status.

The umbilical cord of a newborn is bluish-white in color. After nascence, the umbilical cord is normally cut, leaving a 1–2 inch stub. The umbilical stub will dry out out, shrivel, darken, and spontaneously fall off within well-nigh 3 weeks. Occasionally, hospitals may utilize triple dye to the umbilical stub to prevent infection, which may temporarily color the stub and surrounding skin royal.

Figure three.17 – The clamping and cut of a newborn's umbilical cord.^[35]

Newborns lose many of the above physical characteristics speedily. Thus older babies wait very different. While older babies are considered "cute," newborns can be "unattractive" by the same criteria and first time parents may need to exist educated in this regard.^[36]

Sleep

A newborn typically sleeps approximately 16.v hours per 24-60 minutes period. The infant sleeps in several periods throughout the day and night, which means they wake frequently throughout the day and dark. (Salkind, 2005).^[37]

Figure 3.eighteen – An older newborn baby.^[38]

Reflexes

Newborns are equipped with a number of reflexes, which are involuntary movements in response to stimulation. Some of the more common reflexes, such as the sucking reflex and rooting reflex, are of import to feeding. The grasping and stepping reflexes are somewhen replaced by more voluntary behaviors. Inside the first few months of life these reflexes disappear, while other reflexes, such as the center-glimmer, swallowing, sneezing, gagging, and withdrawal reflex stay with united states as they proceed to serve of import functions.^[39]

Sensory Capacities

Throughout much of history, the newborn was considered a passive, disorganized existence who possessed minimal abilities. Nevertheless, electric current enquiry techniques have demonstrated just how developed the newborn is with peculiarly organized sensory and perceptual abilities.

Vision

The womb is a dark environs void of visual stimulation. Consequently, vision is the most poorly developed sense at birth and time is needed to build those neural pathways between the eye and the brain. Newborns typically cannot see further than viii to 16 inches abroad from their faces, and their visual acuity is nigh 20/400, which means that an infant can encounter something at 20 feet that an adult with normal vision could see at 400 feet. Thus, the world probably looks blurry to young infants.

Figure iii.19 – A newborn gazing up at a parent.^[twoscore]

Hearing

The infant's sense of hearing is very keen at birth, and the ability to hear is evidenced as soon every bit the 7th month of prenatal evolution. In fact, an infant tin can distinguish between very like sounds every bit early every bit one month after birth and can distinguish between a familiar and unfamiliar voice fifty-fifty earlier. Infants are especially sensitive to the frequencies of sounds in human speech and prefer the exaggeration of baby-directed speech, which volition exist discussed subsequently. Newborns likewise adopt their mother'southward voices over another female when speaking the aforementioned fabric (DeCasper & Fifer, 1980). Additionally, they will register in utero specific information heard from their mother'due south voice.^[41]

DeCasper and Spence (1986) tested 16 infants whose mothers had previously read to them prenatally. The mothers read several passages to their fetuses, including the outset 28 paragraphs of The Cat in the Hat, beginning when they were 7 months pregnant. The fetuses had been exposed to the stories on average of 67 times or 3.5 hours.

During the testing, the infants were able to choose between recordings of two stories, one of which was a story their mothers read to them while in the womb, based on how fast they sucked on their pacifiers. They showed a preference for the stories that their mothers read to them while in the womb.^[42]

Figure three.xx – A collection of children's books.^[43]

Affect and Pain

Immediately after nascency, a newborn is sensitive to impact and temperature, and is also highly sensitive to pain, responding with crying and cardiovascular responses (Balaban & Reisenauer, 2013). Newborns who are circumcised, which is the surgical removal of the foreskin of the penis, without anesthesia experience hurting as demonstrated by increased blood pressure, increased middle rate, decreased oxygen in the blood, and a surge of stress hormones (United states of america National Library of Medicine, 2016). Research has demonstrated that infants who were circumcised without anesthesia experienced more hurting and fear during routine babyhood vaccines. Fortunately, many circumcisions are now done with the use of local anesthetics.

Gustatory modality and Odor

Studies of taste and aroma demonstrate that babies respond with different facial expressions, suggesting that certain preferences are innate. Newborns tin distinguish betwixt sour, bitter, sweet, and salty flavors and show a preference for sweet flavors. Newborns too prefer the smell of their mothers. An infant only six days old is significantly more than probable to plough toward its own mother'southward breast pad than to the chest pad of another baby's mother (Porter, Makin, Davis, & Christensen, 1992), and inside hours of nativity an infant also shows a preference for the face of its ain female parent (Bushnell, 2001; Bushnell, Sai, & Mullin, 1989).

Infants seem to be born with the ability to perceive the world in an intermodal fashion; that is, through stimulation from more than than one sensory modality. For example, infants who sucked on a pacifier with a smooth surface preferred looking at visual models of a pacifier with a smooth surface. But those that were given a pacifier with a textured surface preferred to look at a visual model of a pacifier with a textured surface.^[44]

Figure 3.21 – A baby sucking on a pacifier.^[45]

Conclusion

In this chapter nosotros looked at:

• methods of childbirth preparation
• the process of childbirth (for both vaginal and Cesarean deliveries)
• assessing newborn health
• problems for the newborn
• characteristics of newborns (including appearance, reflexes, and perceptual abilities)

In the next three chapters we will explore the starting time 3 years of life more. Many rapid changes occur during these foundational years.

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