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Cd 7

  1. 1. The Baby’s Arrival Chapter 7
  2. 2. The Birth Process <ul><li>A. The beginning of Labor </li></ul><ul><ul><li>1. lightening – baby drops into pelvis area </li></ul></ul><ul><ul><li>2. mucus plug of cervix exits </li></ul></ul><ul><ul><ul><li>a). Prevents bacteria from entering uterus </li></ul></ul></ul><ul><ul><ul><li>b). Mucus liquefies and exits as blood </li></ul></ul></ul><ul><ul><li>3. water breaks </li></ul></ul><ul><ul><ul><li>a). Gush of warm fluid from vagina </li></ul></ul></ul><ul><ul><ul><li>b). Amniotic sac is broken </li></ul></ul></ul><ul><ul><ul><li>c). Usually doesn’t happen until in the hospital in active labor </li></ul></ul></ul><ul><ul><ul><li>d). Want to deliver within 24-48 hours of water breaking </li></ul></ul></ul>
  3. 3. <ul><ul><li>4. Contractions – tightening and releasing of uterine muscle </li></ul></ul><ul><ul><ul><li>a). Just like any other muscle contracts, very strong </li></ul></ul></ul><ul><ul><ul><li>b). Over time they get patterned – longer, stronger, and closer together </li></ul></ul></ul><ul><ul><ul><li>C). Braxton-Hicks </li></ul></ul></ul><ul><ul><ul><ul><li>False contractions </li></ul></ul></ul></ul>
  4. 4. Stages of Labor <ul><li>A. 1 st stage – contractions open the cervix </li></ul><ul><ul><li>1. cervix dilates, widens, to about 10 cm (4 inches) </li></ul></ul><ul><ul><li>2. cervix becomes as thin as a piece of paper – effacement </li></ul></ul><ul><ul><li>3. contractions 60 seconds long, 5-6 minutes apart </li></ul></ul><ul><ul><li>4. Head drops lower in pelvis </li></ul></ul><ul><ul><li>5. If butt, feet first = breech </li></ul></ul><ul><ul><ul><li>a). Dr will evaluate if vaginal birth is possible </li></ul></ul></ul><ul><ul><li>6. End of 1 st – contractions 90 sec, 3-4 minutes apart </li></ul></ul><ul><ul><li>7. Fully dilated </li></ul></ul>
  5. 5. <ul><li>B. 2 nd Stage – baby is born </li></ul><ul><ul><li>1. head slips into vagina from uterus </li></ul></ul><ul><ul><li>2. contractions work to move baby down, rather than stretch cervix </li></ul></ul><ul><ul><li>3. stage may last a few minutes or several hours </li></ul></ul><ul><ul><li>4. culminates into birth of baby </li></ul></ul><ul><ul><li>5. ligaments stretch like rubber bands so baby can fit through bones of pelvis </li></ul></ul><ul><ul><li>6. hormones make ligaments and vagina stretchy </li></ul></ul>
  6. 6. <ul><ul><li>7. baby’s skull is soft and flexible, bones overlap each other so they can fit </li></ul></ul><ul><ul><li>8. episiotomy – cut opening of vagina so baby can fit through – sometimes this happens without cutting – results in tearing which can cause complications after recovery </li></ul></ul><ul><ul><li>9. forceps – guide baby’s head out </li></ul></ul><ul><ul><li>10. vacuum – “sucks” baby out by attaching it to head of baby </li></ul></ul>
  7. 7. <ul><li>C. 3 rd Stage – placenta is expelled </li></ul><ul><ul><li>1. uterus gives birth to placenta </li></ul></ul><ul><ul><li>2. 2-30 minutes </li></ul></ul>
  8. 8. Cesarean Birth <ul><li>A. needed if there is complications </li></ul><ul><ul><li>1. breech </li></ul></ul><ul><ul><li>2. complications during pregnancy </li></ul></ul><ul><ul><li>3. has had a C-section before </li></ul></ul><ul><ul><li>4. V-back = have vaginal birth after a c-section </li></ul></ul><ul><ul><li>5. usually stay 4 days after birth </li></ul></ul><ul><ul><li>6. may be awake during procedure </li></ul></ul>
  9. 9. The Newborn at Birth <ul><li>A. Lungs </li></ul><ul><ul><li>1. fluid is squeezed out of them during the birthing process as it goes through canal </li></ul></ul><ul><ul><li>2. pressure releases and baby’s lungs expand = 1 st breath = cry </li></ul></ul><ul><ul><li>3. fluid suctioned out </li></ul></ul><ul><ul><li>4. if need help to keep breathing – nurse will rub baby’s back </li></ul></ul>
  10. 10. <ul><li>B. Heart </li></ul><ul><ul><li>1. once lungs take in air, CS changes </li></ul></ul><ul><ul><li>2. valve in the heart closes and over the next few days become permanently sealed </li></ul></ul><ul><ul><li>3. blood now circulates through lungs rather than bypassing them </li></ul></ul><ul><ul><li>4. umbilical cord stops pulsing, shrinks minutes after birth and is clamped, tied, and cut off </li></ul></ul>
  11. 11. <ul><li>C. How does a newborn look? </li></ul><ul><ul><li>1. head is wobbly and large </li></ul></ul><ul><ul><ul><li>A. accounts for ¼ of baby’s length </li></ul></ul></ul><ul><ul><li>2. may be lopsided from going through canal </li></ul></ul><ul><ul><li>3. soft spots – fontanels – skull hasn’t joined together to allow for movement </li></ul></ul><ul><ul><li>4. 6-18 months grow together </li></ul></ul><ul><ul><li>5. very tough skin on top to protect brain until the bones grow together </li></ul></ul>
  12. 12. <ul><ul><li>6. fat cheeks </li></ul></ul><ul><ul><li>7. short, flat nose </li></ul></ul><ul><ul><li>8. receding chin </li></ul></ul><ul><ul><li>** the above make it easier for baby to suck b/c nose and chin are out of the way </li></ul></ul><ul><ul><li>9. baby’s eyes are nearly adult size </li></ul></ul><ul><ul><li>10. eyes dark-grayish blue at birth – permanent color apparent within several months </li></ul></ul>
  13. 13. <ul><li>11. skin – grayish – changes as baby’s CS starts working </li></ul><ul><li>12. born early – hair on back, shoulder, forehead – goes away as baby grows </li></ul><ul><li>13. vernix – rich, creamy substance to protect skin </li></ul><ul><ul><li>Some is still present after birth – white </li></ul></ul><ul><ul><li>Can wash off with warm water </li></ul></ul><ul><li>14. milia – white bumps, baby acne </li></ul><ul><ul><li>Plugged oil ducts from maternal hormones </li></ul></ul><ul><ul><li>Disappears in a week or two </li></ul></ul>
  14. 14. The Postnatal Period <ul><li>A. Apgar scale – a method of evaluating a newborn’s physical condition </li></ul><ul><li>Appearance, pulse, grimace, activity, respiration </li></ul><ul><ul><li>1. Gives a rating from 0-2 in each of these 5 areas: </li></ul></ul><ul><ul><ul><li>A. pulse </li></ul></ul></ul><ul><ul><ul><li>B. breathing </li></ul></ul></ul><ul><ul><ul><li>C. muscle tone </li></ul></ul></ul><ul><ul><ul><li>D. reflex to stimulation </li></ul></ul></ul><ul><ul><ul><li>E. skin color </li></ul></ul></ul>
  15. 15. <ul><li>Score of 6-10 is normal </li></ul><ul><li>Anything less needs special medical attention </li></ul><ul><li>Apgar is given 1 minute after birth and then again at 5 minutes </li></ul><ul><li>Baby is also given a brief exam to check for any conditions that might require speical care </li></ul>
  16. 16. <ul><li>Within 60 minutes of delivery, drops of silver nitrate or an antiseptic ointment are put into the baby’s eyes to guard against infection </li></ul><ul><li>Baby is weighed, measured, cleaned up </li></ul><ul><li>Permanent copy of footprints is made for public record </li></ul><ul><li>2 bands giving baby’s family name are clamped to ankle or wrist </li></ul>
  17. 17. <ul><li>Mother wears same bracelet </li></ul><ul><li>Need identification to leave room later </li></ul>
  18. 18. <ul><li>Heart rate </li></ul><ul><li>0 – absent </li></ul><ul><li>1 – under 100 </li></ul><ul><li>2 – over 100 </li></ul>
  19. 19. <ul><li>breathing </li></ul><ul><li>0 – absent </li></ul><ul><li>1 – slow, irregular </li></ul><ul><li>2 – good, crying </li></ul>
  20. 20. <ul><li>Muscle tone </li></ul><ul><li>0 – limp </li></ul><ul><li>1 – some movement </li></ul><ul><li>2 – active motion </li></ul>
  21. 21. <ul><li>Responsiveness </li></ul><ul><li>When nose irritated </li></ul><ul><li>0 – no response </li></ul><ul><li>1 – grimace, distortion of face expressing pain </li></ul><ul><li>2 – cough or sneeze </li></ul>
  22. 22. <ul><li>color </li></ul><ul><li>0 – blue or pale </li></ul><ul><li>1 – body limbs pink, not blue </li></ul><ul><li>2 – completely pink </li></ul>
  23. 23. Bonding and Attachment <ul><li>Bonding – the process of forming lifelong emotional ties </li></ul><ul><li>Delay cutting umbilical cord, cleaning, and giving eyedrops so that parents have the opportunity to begin bonding right away </li></ul><ul><li>Placed in mother’s arms or on stomach to feel skin, hear heartbeat and mother’s familiar voice </li></ul><ul><li>Newborn focuses on mother’s face </li></ul>
  24. 24. <ul><li>Breast feed within minutes of birth </li></ul><ul><li>Baby knows instinctively what to do </li></ul><ul><li>Colostrum – the first breast milk </li></ul><ul><ul><li>Easy for newborn to digest </li></ul></ul><ul><ul><li>Rich in mother’s antibodies </li></ul></ul><ul><ul><li>Yellowish or clear, thick </li></ul></ul>
  25. 25. The Hospital Stay <ul><li>Monitor mother and baby very close as both have gone through drastic changes </li></ul><ul><li>Mother </li></ul><ul><ul><li>Pulse, BP, and other vital signs until all body functions have stabilized </li></ul></ul><ul><li>Stay for 12 hours – bath, eat, rest, medically checked </li></ul><ul><li>Or 2-3 days to recuperate </li></ul>
  26. 26. Rooming - in <ul><li>Rooming-in program </li></ul><ul><ul><li>Arrangement in which the baby stays in the mother’s room, rather than in a hospital nursery, after birth </li></ul></ul><ul><ul><li>Natural beginning to family and bonding </li></ul></ul><ul><ul><li>Homelike atmosphere where visitors can hold baby </li></ul></ul><ul><ul><li>Set a schedule </li></ul></ul><ul><ul><li>Practice caring for baby before going home </li></ul></ul><ul><ul><li>Babies seem more content </li></ul></ul>
  27. 27. <ul><li>Birth certificate </li></ul><ul><ul><li>free of charge soon after baby is born </li></ul></ul><ul><ul><li>Parents fill out a form, temporary certificate is given </li></ul></ul><ul><ul><li>Most important piece of identification </li></ul></ul>
  28. 28. Postnatal care of mother <ul><li>Physical needs </li></ul><ul><ul><li>Rest </li></ul></ul><ul><ul><ul><li>Sleep whenever baby does </li></ul></ul></ul><ul><ul><ul><li>Get help to come so mother can sleep </li></ul></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><ul><li>Simple stretches </li></ul></ul></ul><ul><ul><ul><li>Helps return to normal figure and posture </li></ul></ul></ul>
  29. 29. <ul><ul><li>Nutrition </li></ul></ul><ul><ul><ul><li>Breast feeding – very important to eat correct amount of recommended servings </li></ul></ul></ul><ul><ul><ul><li>Eat right to regain energy </li></ul></ul></ul><ul><ul><ul><li>Drink plenty of water </li></ul></ul></ul><ul><ul><li>Medical checkup </li></ul></ul><ul><ul><ul><li>4-6 weeks after birth </li></ul></ul></ul><ul><ul><ul><li>Dr checks if uterus is returning to normal size </li></ul></ul></ul><ul><ul><ul><li>Mother can discuss any questions or concerns about parenthood or birth control </li></ul></ul></ul>
  30. 30. <ul><li>Emotional needs </li></ul><ul><ul><li>“baby blues” </li></ul></ul><ul><ul><ul><li>Few days of mild depression due to hormonal changes </li></ul></ul></ul><ul><ul><ul><li>Loneliness, resentment </li></ul></ul></ul><ul><ul><li>Make time for just eachother together </li></ul></ul>
  31. 31. Caring for premature babies <ul><li>Weigh less than 5 ½ lbs </li></ul><ul><li>Born before 36 weeks </li></ul><ul><li>Incubator – special enclosed crib in which the O2 supply, temperature, and humidity can be closely controlled </li></ul><ul><ul><li>Baby’s body is not yet ready for heat regulation, sucking, breathing, swallowing </li></ul></ul><ul><ul><li>Baby’s heart and lungs are electronically monitored </li></ul></ul><ul><ul><li>Special meds to combat infection </li></ul></ul><ul><ul><li>Many less than 1 lb now are able to live </li></ul></ul>
  32. 32. <ul><li>Can’t leave hospital until the baby can control his/her body temp and gain weight at the same time </li></ul><ul><li>Detected early, the process can be stopped/prolonged </li></ul>
  33. 33. Journal <ul><li>What do you fear in taking care of a newborn? </li></ul><ul><li>What do you have questions about? </li></ul><ul><li>What do you not know how to do? </li></ul>
  34. 34. A new family member <ul><li>The AMAZING newborn </li></ul><ul><ul><li>Born with remarkable capabilities </li></ul></ul><ul><ul><li>Focus their eyes, hear, smell, vocalize to communicate </li></ul></ul><ul><ul><li>Selectively respond to human voice </li></ul></ul><ul><ul><li>Breathe independently </li></ul></ul><ul><ul><li>Cry for needs </li></ul></ul><ul><ul><li>Prefer human faces to other shapes </li></ul></ul><ul><ul><li>Can follow an object </li></ul></ul>
  35. 35. reflexes <ul><li>Reflex – instinctive, automatic responses, such as sneezing and yawning </li></ul><ul><li>Coordinated behavior helps the baby function </li></ul><ul><li>Some are temporary, some continue throughout life </li></ul>
  36. 36. Types of reflexes <ul><li>1. rooting </li></ul><ul><ul><li>When touched on lips or cheek, the baby will turn toward the touch and begin to suck </li></ul></ul><ul><ul><li>Helps baby find food </li></ul></ul><ul><ul><li>Around 4 months this reflex stops – use eyes and become aware of surroundings </li></ul></ul>
  37. 37. <ul><li>2. grasp </li></ul><ul><ul><li>Response of a newborn’s hand to close over anything that comes into contact with the palm </li></ul></ul><ul><ul><li>3 months baby’s start to reach for object </li></ul></ul><ul><ul><li>Disappears by age of 1 </li></ul></ul>
  38. 38. <ul><li>3. startle </li></ul><ul><ul><li>Response to a loud noise or touch on the stomach </li></ul></ul><ul><ul><li>Legs thrown up, fingers spread, arms extended, then bring back to midline with clenched fists </li></ul></ul><ul><ul><li>Lasts about 5 months </li></ul></ul>
  39. 39. Learning to care for newborn <ul><li>What do babies need </li></ul><ul><ul><li>Food </li></ul></ul><ul><ul><ul><li>Get to them right away so they learn to trust those around them </li></ul></ul></ul><ul><ul><li>Sleep </li></ul></ul><ul><ul><ul><li>Sleep throughout the day </li></ul></ul></ul><ul><ul><ul><li>Wake up 1-3 times/night to feed </li></ul></ul></ul><ul><ul><ul><li>Average of 15/day </li></ul></ul></ul>
  40. 40. <ul><ul><li>Exercise </li></ul></ul><ul><ul><ul><li>Helps develop muscle tone and nervous system </li></ul></ul></ul><ul><ul><ul><li>Splashing during bath </li></ul></ul></ul><ul><ul><ul><li>Kicking while diaper changing </li></ul></ul></ul><ul><ul><li>Kept safe, clean, and warm </li></ul></ul><ul><ul><ul><li>Make your house baby safe </li></ul></ul></ul>
  41. 41. <ul><ul><li>Medical care </li></ul></ul><ul><ul><ul><li>Periodic check-ups </li></ul></ul></ul><ul><ul><ul><li>Check if developing normal </li></ul></ul></ul><ul><ul><ul><li>Immunizations </li></ul></ul></ul><ul><ul><li>Need things to look at, touch, listen to, and play with </li></ul></ul><ul><ul><ul><li>Need to be stimulated to learn </li></ul></ul></ul><ul><ul><li>Love </li></ul></ul><ul><ul><ul><li>Close contact </li></ul></ul></ul><ul><ul><ul><li>touched </li></ul></ul></ul>
  42. 42. What do parents need <ul><li>Knowledge to care for infant </li></ul><ul><li>Resources for any ?’s </li></ul><ul><li>Time </li></ul><ul><li>Emotional support </li></ul><ul><li>Financial planning </li></ul><ul><li>Reassurance and confidence </li></ul><ul><li>Agreement about responsibilities </li></ul><ul><li>Personal health/rest </li></ul><ul><li>Privacy, time alone </li></ul>
  43. 43. Adjusting to new routines <ul><li>Trial and error </li></ul><ul><li>Cannot spoil too much in the first months </li></ul><ul><li>Make a routine, schedule </li></ul><ul><ul><li>Good for babies and kids to know what to expect </li></ul></ul>
  44. 44. Understanding the Baby’s language <ul><li>Hunger is usually the reason they cry </li></ul><ul><li>Fatigue, loneliness, uncomfortable </li></ul><ul><li>Average is 1 hr/day </li></ul><ul><li>Recognize different cries </li></ul>
  45. 45. Journal <ul><li>What was your temperament as a child? </li></ul><ul><li>Assignment – ask your mom or dad what you were like as an infant. </li></ul>
  46. 46. Early Temperament <ul><li>Temperament – style of reacting to the world and of relating to others </li></ul><ul><li>Baby will have own style to reacting to situations and their personality </li></ul>