End of pregnancy
hormonalchangestake place (release of oxytocin) begins birth process
Oxytocin:
hormone released by pituitary gland that starts labor and at a certain level induces contractions
Birth process occurs
in 3 stages
Birth Process: Stage One - Labor:
cervix dilates, muscles of the uterus contract to push the fetus into the vagina towards the cervix
� Contractions are painful and at their peak last 60 to 90 seconds and occur less than a minute apart
� Cervix will dilate to 10 cm to allow fetus to pass
Birth Process: Stage Two - Delivery
fetus is pushed out of the cervix and through the birth canal
� In addition to contractions, woman will feel the urge to push
-usually short, half hour to hour.
� Crowning: baby's head appearing at the outer opening of vagina
Birth Process: Stage Three - Expulsion
� Contractions continue as the placenta and umbilical cord are expelled from the uterus
� Typically happens within a few minutes to half an hour after birth, contractions are mild lasting about one minute each
� Failure to expel whole placenta will result
Birth Process: Complications
Breech presentation:
positioning of the fetus so that feet or buttocks, rather than head, are positioned to come out first in the birth canal
� Dangerous to deliver because can cause constriction of umbilical cord resulting in insufficient oxygen and brain damage
� Baby may b
Birth Process: Complications
Failure to progress:
birth process has stalled in the labor stage and cervix is not dilating as required
� Progress may be stimulated by walking, sleep, enema, or herbs
� In hospital births, mother may be given Pitocin (synthetic oxytocin) to progress labor (to dilate cervix
Birth Process: Complications
Cesarean Delivery (c-section) :
mother's abdomen is cut open and fetus is retrieved directly from the uterus
� Longer healing time than vaginal birth
� Frequently used to prevent transmission of sexually transmitted diseases like genital herpes and HIV/Aids
Birth Process: Complications
( aren't available in certain places)
(there has been a rise of c sections)
� Rise of c-sections may be the result of caution due to new and growing information available regarding birth and the birth process
� C-section rates are low in places with limit
Birth Process: Historic Context
� In the West, early history - it was all midwifery
� Midwives were widely valued and respected (given gifts and house)
� 15th century, witch hunting brought down the profession
� When died down, midwives were required to have licenses issued by the Catho
Birth Process: Historic Context
� 18th century, rise of the medical profession and new field called obstetrics
� Doctors became favored over midwives
� Major concern of the time was spread of disease
� 1 in 20 women died during child birth from fever and illness that 75% contracted it d
Birth Process: Historic Context
� 20th century, slow progress, illness post pregnancy not vanquished till 1940's
� Twilight sleep - commonly used drugs to ease pain during birth, left mothers unresponsive
� Commonly used medications and twilight sleep through the 30's, 40's and 50's ( a
Birth Process: Historic Context
� 1960's backlash, less use of drugs. Return to natural childbirth and midwifery
� Today birth process has many options and woman frequently develop a plan in advance (and the steps you are going to take/things to prepare)
Birth Process: Cultural Variations
�Ila people of Zimbabwe
� have people come and Women attending birth shower praise on the women having the baby
� Post birth, husband come in to congratulate her
� Husband is followed by male relatives bringing gifts and clasp her hand
Birth Process: Cultural Variations
�Arapesh people of New Guinea
� Birth may take place only on the outskirts of the village
� Place outside village reserved for menstruation, excretion, and child birth
� Belief birth process is unclean and may bring unwanted spirits to the village
Birth Process: Cultural Variations
� In traditional Vietnam
� Mother avoids leaving hut for 30 days post birth
� Not contaminate the village or endanger herself or the infant
� Husband not allowed to enter the hut and must speak to mother from outside the door (husband doesn't meet kid until 30 days after born)
Birth Process: Cultural Variations
Why would these beliefs develop?
� Desire for control
� Response to disease and death associated with birth
� Births are assisted by women, leaving some aspect of mystery and speculation by others
� Traditions may include cultural ways to ease birth process, religious rituals, or what to
Neonate:
newborn baby, up to 4 weeks old
The neonate: Newborn health
� Lanugo:
fine, fuzzy hair may cover the baby, will be shed in few days
The neonate: Newborn health
�Vernix:
oily,cheesy substance that protected neonate skin in the womb
know steps, and problems that can cause, different cultures.
...
The neonate: Newborn health
� Newborns will lose 10% of their weight in the first few days, will begin regaining back at around 5 days
� Newborns may have misshapen heads (particularly vaginal births)
� Fontanels:
soft spots on the skull between skull pieces that shift during birth process to allow passage through birth canal
Apgar Scale:
neonatal assessment scale with 5 subtests ( lower score more concerned for more problems)
Brazelton Neonatal Behavioral Assessment:
used commonly in europe
27- item scale which rates overall neonate functioning
Newborn Health Concerns
Low Birth Weight: less than 5.5 lbs
� Very Low Birth Weight: less than 3.3 lbs
� Extremely Low Birth Weight: less than 2.2 lbs
� Small for Date: Neonates who weigh less than 90% of neonates born at same gestational age
Low Birth Weight (biggest concern)
Causes:
� Mothers smoking
� Malnourished mothers
� Poor health, no prenatal care
� Multiple births
� Use of alcohol or drugs
� Young or old maternal age (under 17 or over 40)
Low Birth Weight
� Consequences:
-High risk of death 1st year of life
� Teratogen exposure
-Physical problems
� Asthma, lack of immune system
- Cognitive problems
� Language delays, poor school performance
-Brain abnormalities
� Attention deficits, low intelligence scores
Low Birth Weight
� Treatment:
-Kangaroo care
� Skin to skin contact 2-3
hours a day
- Infant massage
� Sensory and social stimulation
-Isolette
� Sterile chamber provides oxygen and controls body temperature
Neonate: Physical Functioning
Sleeping Patterns:
� More time asleep than awake
� 16 to 17 hours a day in few hour spurts (2-4 hours at a time)
� 50% of sleep is REM, uncertain purpose of this ( no one knows why they spend so much time in REM)
Neonate: Physical Functioning
Grasping reflex -
press a neonate's palm and will grasp with strength
Rooting reflex -
touch cheek, turn towards touch and open mouth
Sucking reflex -
rhythmic nursing (suckling) when something inserted into mouth
Moro reflex -
startling and flinging out of arms when disturbed
Babinski reflex -
foot is stroked, toes fan out
Stepping reflex -
held upright with feet on solid surface, baby
appears to take steps or dance
Neonate: Physical Functioning
� Senses:
- Touch, taste, hearing and smell are well developed in the womb
- Newborns will show affinity for what they were exposed to in utero from sounds to smells and even tastes (based on mother's diet during pregnancy)
-sight is least developed and newborns ar