2

Children
Birth & the Neonate
2.4
Birthing Methods & Delivery
Options

What Happens During Birth?

 99% of U.S. births in hospitals
 Other options

– Free...
Birthing Methods & Delivery
Options
 Who helps varies across cultures

– 91% U.S. births physicians
– Some exclude father...
What Happens During Birth?

Birthing Methods & Delivery
Options
 Midwives

– Norm, most of world
– U.S. Attend 8% births
...
Birthing Methods & Delivery
Options

What Happens During Birth?

 Doulas

– No medical care
 Do not deliver babies

– Su...
Birthing Methods & Delivery
Options

What Happens During Birth?



Natural childbirth
– Goal: reduce pain by reducing fea...
Birthing Methods & Delivery
Options

What Happens During Birth?

 Other methods to reduce pain & stress

during labor & c...
Stages of Birth
 3 stages of birth

– Stage 1
 @ 12 - 24 hrs.

– Stage 2
 @ 45 min’s - 1 hour

– Stage 3
 Lasts only m...
Effacement of the Cervix
Becomes

– Thinner
– Shorter
Starts

– Couple weeks before delivery
What Happens During Birth?

Stages of Birth
 1st stage: Dilation & Effacement of the

Cervix

– @ 12 - 24 hrs.
 Longest ...
What Happens During Birth?

Stages of Birth
 2nd

stage : Delivery of the
Baby
– @ 45 min’s - 1 hour
– Begins when:
 bab...
Stages of Birth
 3rd stage: Placenta (afterbirth)

– Placenta, umbilical cord, & other
membranes detached & expelled
– Fa...
What Happens During Birth?

Cesarean Section
 Cesarean Delivery

– Baby removed from uterus through incision in
abdomen w...
NEWBORN ASSESSMENT
PRETERM, LOW BIRTH
WEIGHT, SMALL-FOR
DATE
Preterm & Small-for-Date
Infants
 Low-birth-weight infant under 5.5 lbs

– Very low - under 3 lbs
– Extremely low - under...
Preterm & Small-for-Date
Infants
 Small for date

– May be preterm/full term
– Birth weight below normal
 Increased use ...
Preterm & Small-for-Date
Infants



Consequences of preterm & LBW
Most low birth weight infants
– normal & healthy



A...
Consequences of Preterm &
LBW
•

Norwegian study
– Preterm-birth adolescents higher risk for:
 language delays
 learning...
2.5

INFANT CARE
The Postpartum Period

Bonding
 Close connection, especially physical

bond, between parents & newborn in
period shortly ...
The Postpartum Period

Postpartum Depression


Period after childbirth
– Mother adjusts physically & psychologically to
p...
8. Postpartum Period
The Postpartum Period

Postpartum Depression
 Emotional & Psychological Adjustments

– Emotional fluctuations due to:
 H...
Emotional & Psychological
Adjustments
 Postpartum depression

– Strong feelings of
 Sadness
 Anxiety
 Despair

– Gets ...
Emotional and Psychological
Adjustments

The Postpartum Period

 Postpartum depression treatments

– Antidepressants
– Ps...
Emotional and Psychological
Adjustments

The Postpartum Period

 Father’s adjustment

– Considerable adjustment & stress
...
Infant Nutrition & Health
• Infants in 1 yr.
 Triple weight
– Increase length 50%
– 50 calories per day per
lb. of weight...
Infant Nutrition & Health
 Healthy infants need:
– Loving, supportive feeding environment
– Breast milk
– Gradual increas...
How Do Infants Grow and Develop
Physically?

Co-sleeping

 Culture and Sleeping Arrangements

– Sharing bed common in man...
Sudden Infant Death Syndrome
(SIDS)
How Do Infants Grow and Develop
Physically?

 Infant stops breathing, usually during
...
Sudden Infant Death Syndrome
(SIDS)
 Thoughts?
Sudden Infant Death Syndrome
(SIDS)
How Do Infants Grow and Develop
Physically?

 Highest risks

–
–
–
–
–
–
–
–

Lower b...
How Do Infants Grow and Develop
Physically?

Breast Versus Bottle Feeding


Breast milk
–
–
–
–
–
–
–
–

Fewer gastrointe...
How Do Infants Grow and Develop
Physically?

Malnutrition in Infancy
 Early weaning can

cause deficiencies
 Can develop...
Malnutrition in Infancy
Kwashiorkor
 Deficiency in protein
 Abdomen, feet
swollen with water
 If not fatal, effects
det...
Nonorganic Failure to Thrive
 Child may die
 Occurs before 18 mo.'s.
 Denied

–
–
–

Affection
Emotional Support
Stimul...
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Child chapter 2.4

  1. 1. 2 Children Birth & the Neonate 2.4
  2. 2. Birthing Methods & Delivery Options What Happens During Birth?  99% of U.S. births in hospitals  Other options – Freestanding birth center – Home delivery
  3. 3. Birthing Methods & Delivery Options  Who helps varies across cultures – 91% U.S. births physicians – Some exclude fathers – Some family members – Open to community
  4. 4. What Happens During Birth? Birthing Methods & Delivery Options  Midwives – Norm, most of world – U.S. Attend 8% births – U.S. certified nurse midwives  Deliver babies – More time with patient in prenatal visits – Counseling, education – Emotional support
  5. 5. Birthing Methods & Delivery Options What Happens During Birth?  Doulas – No medical care  Do not deliver babies – Support before, during, & after childbirth  Physical  Emotional  Educational – Most in U.S. work independently, typically function as part of ‘birthing team’
  6. 6. Birthing Methods & Delivery Options What Happens During Birth?  Natural childbirth – Goal: reduce pain by reducing fear  Education  Breathing techniques  Relaxation techniques  Prepared childbirth (Lamaze method) – Similar to natural childbirth – Special breathing technique in final stages of labor
  7. 7. Birthing Methods & Delivery Options What Happens During Birth?  Other methods to reduce pain & stress during labor & childbirth – Waterbirth – Massage – Acupuncture – Hypnosis – Music therapy
  8. 8. Stages of Birth  3 stages of birth – Stage 1  @ 12 - 24 hrs. – Stage 2  @ 45 min’s - 1 hour – Stage 3  Lasts only minutes
  9. 9. Effacement of the Cervix Becomes – Thinner – Shorter Starts – Couple weeks before delivery
  10. 10. What Happens During Birth? Stages of Birth  1st stage: Dilation & Effacement of the Cervix – @ 12 - 24 hrs.  Longest stage – Contractions @ 15 – 20 min’s apart  Closer together as birth nears – Contractions dilate cervix to open @ 4 inches .  Allows baby to move into birth canal
  11. 11. What Happens During Birth? Stages of Birth  2nd stage : Delivery of the Baby – @ 45 min’s - 1 hour – Begins when:  baby’s head moves through cervix & birth canal – Ends when:  baby completely emerges – Mother pushes down, contractions come @ every minute
  12. 12. Stages of Birth  3rd stage: Placenta (afterbirth) – Placenta, umbilical cord, & other membranes detached & expelled – Fastest stage  minutes
  13. 13. What Happens During Birth? Cesarean Section  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 – http://www.youtube.com/watch?v=vjgxKcjnimY
  14. 14. NEWBORN ASSESSMENT
  15. 15. PRETERM, LOW BIRTH WEIGHT, SMALL-FOR DATE
  16. 16. Preterm & Small-for-Date Infants  Low-birth-weight infant under 5.5 lbs – Very low - under 3 lbs – Extremely low - under 2 lbs  Preterm – Born 3 or more weeks early
  17. 17. Preterm & Small-for-Date Infants  Small for date – May be preterm/full term – Birth weight below normal  Increased use of progestin to prevent preterm births – Lowered preterm births 1/3
  18. 18. Preterm & Small-for-Date Infants   Consequences of preterm & LBW Most low birth weight infants – normal & healthy  As a group – – • More developmental & health problems Risk increases as gestation age decreases Potential problems include • • • • brain injuries lung & liver diseases learning disabilities breathing problems
  19. 19. Consequences of Preterm & LBW • Norwegian study – Preterm-birth adolescents higher risk for:  language delays  learning problems  behavior problems/delinquency involvement
  20. 20. 2.5 INFANT CARE
  21. 21. The Postpartum Period Bonding  Close connection, especially physical bond, between parents & newborn in period shortly after birth – Doctors suggest:  “rooming in” – Newborn kept in mother's hospital room  Immediate bonding – Not necessary for emotional health  Adoption?
  22. 22. The Postpartum Period Postpartum Depression  Period after childbirth – Mother adjusts physically & psychologically to process of childbearing – Lasts about @ 6 weeks  Involution – Process by which uterus returns to pre-pregnant size – 5 - 6 weeks
  23. 23. 8. Postpartum Period
  24. 24. The Postpartum Period Postpartum Depression  Emotional & Psychological Adjustments – Emotional fluctuations due to:  Hormonal changes  Fatigue  Inadequate rest  Inexperience or lack of confidence  Extensive demands may cause – Anxiety, depression, coping difficulties
  25. 25. Emotional & Psychological Adjustments  Postpartum depression – Strong feelings of  Sadness  Anxiety  Despair – Gets worse without treatment
  26. 26. Emotional and Psychological Adjustments The Postpartum Period  Postpartum depression treatments – Antidepressants – Psychotherapy; cognitive therapy is best  Postpartum depression affects – Mother-infant interaction – Risk of additional psychological disorders
  27. 27. Emotional and Psychological Adjustments The Postpartum Period  Father’s adjustment – Considerable adjustment & stress  Attention on infant decreases couple’s time  May feel unneeded – Father’s postpartum reactions  Prenatal involvement can lessen feelings of depression
  28. 28. Infant Nutrition & Health • Infants in 1 yr.  Triple weight – Increase length 50% – 50 calories per day per lb. of weight – High-calorie, highenergy foods & fats very important  NO NONFAT FOODS
  29. 29. Infant Nutrition & Health  Healthy infants need: – Loving, supportive feeding environment – Breast milk – Gradual increase of chew-&-swallow – More fruits & vegetables, less junk food – Demand feeding becoming more popular – Poor dietary patterns can cause overweight
  30. 30. How Do Infants Grow and Develop Physically? Co-sleeping  Culture and Sleeping Arrangements – Sharing bed common in many cultures – American Academy of Pediatrics – Discourages co-sleeping because of Stress SIDS risk
  31. 31. Sudden Infant Death Syndrome (SIDS) How Do Infants Grow and Develop Physically?  Infant stops breathing, usually during night, and dies without apparent cause – – – – – – Highest cause of infant death in U.S. Highest risk is 2 - 4 mo.'s of age Sleeping on back reduces risk Less common in: bedroom with fan infant who sleeps with pacifier
  32. 32. Sudden Infant Death Syndrome (SIDS)  Thoughts?
  33. 33. Sudden Infant Death Syndrome (SIDS) How Do Infants Grow and Develop Physically?  Highest risks – – – – – – – – Lower birth weight Siblings with SIDS Sleep apnea Lower SES groups Exposure to cigarette smoke Placement in soft bedding Abnormal brain stem functioning African American & Inuit infants
  34. 34. How Do Infants Grow and Develop Physically? Breast Versus Bottle Feeding  Breast milk – – – – – – – – Fewer gastrointestinal infections Lower respiratory tract infections Reduces effects of asthma in first 3 mo’s Reduce risk of skin inflammation May lessen likelihood of obesity Lowers risk of childhood & adult diabetes Less risk of experiencing SIDS Claims of no link to allergy prevention
  35. 35. How Do Infants Grow and Develop Physically? Malnutrition in Infancy  Early weaning can cause deficiencies  Can develop: – Marasmus – Wasting away of body tissues infant’s 1st yr.
  36. 36. Malnutrition in Infancy Kwashiorkor  Deficiency in protein  Abdomen, feet swollen with water  If not fatal, effects detrimental  Lowest SES  Aided by supplementary feeding
  37. 37. Nonorganic Failure to Thrive  Child may die  Occurs before 18 mo.'s.  Denied – – – Affection Emotional Support Stimulation  Harry Harlow experiment
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