Prenatal development occurs in three stages: germinal, embryonic, and fetal. During the germinal stage, the fertilized egg implants in the uterus and begins cell division. In the embryonic stage, organs begin to form through organogenesis. The fetal period begins at 8 weeks when organogenesis is complete and the fetus continues growing and developing until birth. Risks during prenatal development include teratogens like alcohol, drugs, and infections from the mother. Critical periods of development include implantation and organogenesis when the fetus is most vulnerable. The birth process involves three stages of labor and delivery options like Lamaze or home birth. Assessments of the neonate include Apgar scores and routine tests are done to prevent issues.

1. Prenatal Development & Birth
Chapter 3

2. Conception
• Strategies
– The old fashioned way
– In vitro
– Surrogate
– Artificial insemination
• Following ovulation, fertilization occurs in
fallopian tube
• Cell division occurs in the zygote
• Flows into uterus

3. Prenatal Development
• Germinal Stage
– Fertilized egg not yet implanted in the uterus
– Upon initial cell division the fertilized egg
becomes a zygote
– At approximately 12 days following fertilization,
zygote is implanted in the lining of the uterus
– Cells specialize into what will become organs

4. Prenatal Development
• Embryonic Stage
– Differentiation of tissues into what will become organs
(organogenesis)
– Movements to stimuli based on “hard-wired” reflexes;
– Critical period of pregnancy in that as organogenesis
occurs, anomalies can result in miscarriage
– Umbilical cord and placenta develop and provide nutrition
and oxygen to and remove waste from the embryo
– Developmental patterns:
• Cephalocaudal Patterns
• Proximodistal Patterns

5. Prenatal Development
• Fetal Period
– Begins approximately 8 weeks post fertilization
– Organogenesis is complete
– At approximately 3 months, genitalia can be identified
– At approximately 4 months, movements can be felt by the
mother
– At approximately 7 months fetus may be “viable” (can
survive outside the womb with nutrition and temperature
regulation support).

6. Brain Development during Prenatal Period and
Beyond
• Growth: brain cells develop from the neural tube
across the prenatal period and into infancy
• Migration: brain cells migrate or move from the
center of the developing brain to the periphery
• Elaboration:
– connections among the axons and dendrites of
the cells are based on genetics during the prenatal
period;
– postnatal experience (nurture) enhances and
inhibits elaboration (e.g. first 6 months of life the
infant is particularly “wired” to learn sounds of
language)

7. Risks during Prenatal Development
• Teratogens: Toxins that impact the developing
organism prenatally
– Nicotine—increased heart rate; low birth weight
– Alcohol—fetal alcohol syndrome (mental retardation,
physical abnormalities)
– Rubella (German measles)—can be transmitted from
pregnant mother to fetus; can result in blindness, other
physical problems, and death
– HIV—without medication can be transmitted from
pregnant mother to fetus
– Psychoactive drugs—multiple effects

8. Risks during Prenatal Development
• Maternal Anxiety and Stress during late
pregnancy related to:
– Attentional problems
– Reactions to novelty
• Maternal Age (extremely young and older)
• STD’s
– Herpes
– HIV/AIDS
– Syphilus

9. Critical Periods in Gestation
• Points at which key transitions occur tend to
be the most critical
– Attachment to the uterine wall
– Organogenesis tends to most vulnerable to major
“malformations.” (Germinal Stage)
– Chronic exposure to toxins during fetal stage
linked to delay in fetal growth and deficits in
intellectual potential (fetal stage)

10. Father’s Role
• Health of Sperm—toxins, radiation, drugs and
alcohol
• Supportive partner—emotional support, support for
alcohol & tobacco free pregnancy
• Support and encourage access to health care

11. Birth Process
• Stage 1:
– Dilation
• Early labor
– Initial irregular uterine contractions
– Dilation or Effacing of the cervix to begin the
birthing process
• Active labor
– Contractions become more regular and intense
– Go to the birthing center/hospital
– Cervix continues to efface

12. Birth Process
• Stage 2
– “Push” mode
– Fetus enters birth canal
– Birth occurs
• Stage 3
– Contractions continue through delivery of
placenta

13. Birth Process: Birthing Options
• Lamaze Method
– Focusing
– Relaxation
– Breathing
– Knowledge and understanding
– Partner and shared experience

14. Birth Process: Birthing Options
• Leboyer Method
– Alternative context
– Home-like atmosphere
– Neonate is placed on the mother’s chest with
umbilical cord in place
• Home birth
– Screened for potential complications
– Birthing professional present (e.g. Midwife, Nurse
Practitioner)
– Family/Partner involved

15. Birth Process: Birthing Options
• Drugs during labor & delivery
– Overall, minimizing use of drugs during labor and
delivery is best
– General impact on neonate and infant is short
term
– More fragile (preterm, low birth weight) infants at
greatest risk for negative outcomes with drugs
– Drugs reduce mother’s ability to “push” during
labor and delivery

16. Birth Process: Birthing Options
• Maternal comfort and safety is most
important in selecting birthing option
• Pregnancy complications can limit safe
options
• Prenatal health
– Emotional support
– Nutrition
– Exercise
– Prenatal health care

17. Neonatal Condition
• Apgar (1 minute & 5 minutes; Scores: 0, 1, or
2)
– Heart rate.
– Skin color.
– Muscle tone (judged by whether the newborn's
arms and legs are flexed or limp).
– Breathing.
– Reflex irritability (judged by whether the newborn
cries or reacts when the skin is stroked or
touched).

18. Neonatal Condition
• Phenylketonuria (PKU) test for neonates
• Hearing
• Antibiotic eyedrops
• Vitamin Injections
• Early breast feeding provides antibodies
• Caring, supportive, safe, and healthy
environment