Chapter 4 s13

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Chapter 4 s13

  1. 1. Chapter 4Prenatal and Birth
  2. 2. Early Timetable of Prenatal Development,Adapted from Figure 4.1, page 90Sun Mon Tues Wed Thurs Fri Sat 1 2 3 4 Last menstrual period5 6 7 8 9 10 1112 13 14 15 16 17 18 Ovulation Fertilization19 20 21 22 23 24 25 Zygote Implantation Ends attaches to Begins wall26 27 28 29 30 Placenta, First umbilical menstrual cord dev. period missed
  3. 3. Signs of Pregnancy Nausea Fatigue BreastTenderness Missed Period
  4. 4. Prenatal Development Begins at conception Ends at birth Proceeds through three stages:  Germinal stage  Embryonic stage  Fetal stage
  5. 5. Prenatal Development  Germinal Stage  Conception until the fertilized egg implants into the uterine wall  About 2 weeks • Triggers 1st • Zygote Zygote • Attaches signsFertilization to wall Hormonal • Cell travels to • Umbilical of egg Divides • 1mm in Change Uterus cord diameter • Placentahttp://www.whattoexpect.com/pregnancy/week-by- http://www.babyzone.com/pregnancy-week-by-week/weeks-1-and-2.aspx# week/
  6. 6. Germinal Stage Complications  Ectopic Pregnancies  Outside of the uterus  1 out of 100 pregnancies  Multiples  1 out of 80 pregnancies  Twin pregnancy 4x greater than twin births (often 1 embryo spontaneously aborts early in development  3 or more babies 4x greater since 1980s
  7. 7. Prenatal Development  Embryonic Stage  Implantation until about eight weeks  Usually 2-8 weeks  Major organs and body parts develop daily; environmental damage most likely to occur  Three layers of cells (around 3rd week): 1) Ectoderm - Skin cells, Nervous system 2) Mesoderm - Muscles, bones, circulatory system 3) Endoderm - Digestive System and lungshttp://ultrasound-images.com/fetal-heart.htm
  8. 8. Embryonic Stage Cephalocaudal Development  Growth occurs from the head downwards Proximodistal Development  Growth occurs from the central axis (center of the body) outwards 95% of the major body structures are developed and some are functioning
  9. 9. Prenatal Development Fetal Stage  Weeks 9-birth  Existing organs and structures become defined  Brain develops rapidly  16th week Quickening – fetal movements  Rate growth during the fetal stage is greater than at any other time  7th month survival is possible with NICU
  10. 10. Germinal Embryotic Fetal 1st 2nd 3rd Trimester Trimester Trimester
  11. 11. Conditions Influencing Pregnancyand Prenatal Development 80% of birth defects caused by environmental problems during prenatal development Two lines of protection from environmental influences:  Amniotic fluid – protects the fetus from physical injuries  Placental barrier – created by blood vessel walls that separate the maternal and fetal circulatory system
  12. 12. Teratogens / Environment Teratogen – agents that cross the placental barrier and cause or increase the incidence of physical, behavioral, and/or cognitive deficits in children Severity depends upon:  When exposed  Amount of exposure  Fetal characteristics
  13. 13. Teratogen Effects There is a similar table in your textbook on page 97
  14. 14. Some Possible Teratogens Disease – rubella, syphilis, pediatric aids, etc. Drugs– alcohol, cigarettes, cocaine, heroin, etc. Environmental– lead, pesticides, radiation, chemicals, etc.
  15. 15. Other Conditions Affecting Pregnancy  Maternal Age  35 yrs old + - risks increase  Down syndrome  High blood pressure  Gestational diabetes  Miscarriage  Twins
  16. 16. Other Conditions Affecting Pregnancy  Maternal Stress  Stress produces hormones that cross placental barrier and effect fetus  Extreme and prolonged stress increases the risk for:  Miscarriage  difficult labor and delivery  prematurity
  17. 17. Other Conditions Affecting Pregnancy  Parity:  Number of children  Spacing between children A woman’s endocrine system takes four years to return to pre-pregnancy condition A pregnancy within 3 months of delivery is classified as high-risk
  18. 18. Protective Factors Nutrition  Good food + weight gain = healthy baby  Iron, protein, folic acid, water Exercise  Provides more energy, builds bones and muscles, improves health, and increases ability to cope with childbirth pain
  19. 19. Protective Factors Prenatal Care  Lower rates of birth complications Social Support  Minimizes effects of stress and helps in dealing with physical demands or complications that arise during pregnancy
  20. 20. How is a Baby Born? The Birth Process  280 Days = Due date  Only 3% of babies born on due date  45% within one week (before or after)
  21. 21. What Triggers Labor? Mother’s body releases  Prostaglandis (fatty acids)  Oxytocin (hormone)  Change in uterus molecules Lightening  Baby drops into the pelvic cavity; pressure is decreased on the mother’s diaphragm  Mother can breathe easier
  22. 22. The Birth Process Braxton-Hicks Contractions  Throughout pregnancy and especially during the last month or two  Mild irregular contractions of the uterus False Labor  During late pregnancy  Moderately intense and rhythmic contractions
  23. 23. The Birth Process Stage 1: Dilation of the Cervix  True Contractions  30-60 seconds; 5-20 minutes apart  Cervix working towards opening to 10cm; mucous plug is dislodged  Amniotic sac may tear – aka “water breaks”  Transition phase – last part of dilation  Epidural block (blocks pain from the waist to the feet) may be given so cervix can continue to dilate fully before mother begins pushing  Heart rate of baby monitored
  24. 24. The Birth Process  Stage 2: Birth of the baby  Cervix is fully dilated  Contractions help push baby out  60 seconds; 1-3 minutes apart  Crowning  When the top of the baby’s head becomes visible  Molding  baby’s bones in skull, which are not yet fused, press together and may even overlap to help baby pass through the birth canal
  25. 25. The Birth Process Stage 2: Birth of the baby  Episiotomy A small incision in the skin below the vagina may be needed to create a larger opening for the baby’s head  Delivery  As short as 5 minutes  1-2 hours for first time moms  Baby turns so the shoulders can fit through vaginal opening  After shoulders are delivered the rest of the baby slides out
  26. 26. The Birth Process Stage 3: Expulsion of the Placenta  15 – 30 minutes after delivery  Contractions continue, helping the placenta move through the birth canal  No longer needed https://www.youtube.com/watch?v=mOP52g_rO24
  27. 27. Birthing Methods 19th century – Midwives 1950s – at hospital Today – 99% delivered at hospital Options for families  Birthing centers  Bathtub  Midwives  Family/coach in room
  28. 28. Birthing Methods Lamaze Childbirth  Six weekly sessions, learn how to:  Breathe during labor and delivery to control pain and discomfort  Focus on relaxing thoughts and feelings  Have fathers or other partners help in labor and delivery
  29. 29. Birthing Methods Leboyer Method  Minimize infant’s trauma  Mimics the conditions of the mother’s womb  Dim lighting  Delivery room temperature closer to mother’s body temperature  After delivery and before the umbilical cord is cut, the naked infant is placed on mother’s bare belly  The infant is given a warm bath
  30. 30. Complications Cesarean Sections  A non-vaginal birth where the fetus is delivered through an incision in the mother’s abdomen  Delay in delivery, compromise health of infant  United States - 900,000 per year Table 4.1, page 112 1. Unfavorable shape of pelvis 2. Breech presentation 3. Placenta previa 4. Cord prolapse 5. Fetal distress 6. Eclampsia 7. Prolonged labor 8. Diabetes
  31. 31. Complications Breech presentation  Baby is bottom or feet first Transverse presentation  Shoulders or arms leading Induced Labor  Pitocin or other medication  About 20% of women 1999
  32. 32. Mother’s Perspective “Baby”Blues” - 70-80% of new mothers experience - contributing factors:  Biological changes  Fatigue  Loss of attention  Increased demands at home  Sense of anticlimax  Feelings of inadequacy Postpartum depression  Intense feelings of sadness, anxiety or despair that disrupt the mother’s ability to function and interact with her child
  33. 33. Fatherhood Readiness Mature Regress Actively Loss of freedom participate Aware of Loss of Personal attention relationships Closeness to Jealous spouse
  34. 34. Newborns – also known as Neonate Stress hormones released during delivery Causes newborn to be alert  Helps lungs  Can withstand stress  Increases metabolism  Increases energy supply  May promote development of emotional ties between parents during first hours of life  Not present for cesarean delivered newborns
  35. 35. Characteristics of Newborn/Neonate Newborn/Neonate  Infants who are adapting to life outside the womb, usually first month or two  Four big goals of the newborn/neonate:  Breathe on their own  Blood circulation  Control body temperature  Ingesting food
  36. 36. Four Big Goals of Newborn…. Breathe on their own  Newborn must switch from oxygen provided by the umbilical cord blood to breathing on his own Blood circulation  When the link to the placenta is severed, circulation changes so that blood flows to the lungs for the first time.
  37. 37. Four Big Goals of Newborn…. Control body temperature  The environment outside the womb is susceptible to extreme changes in temperature Ingesting food  In utero, nutrients are provided through the placenta. After birth, the newborn must learn how to obtain nourishment through the mouth
  38. 38. Characteristics of Newborn/Neonate Avg. Length 19-21 inches Avg. weight 7 – 7.5 pounds Vaginal Delivery  Misshaped head  Swollen face  Flat nose White waxy covering – vernix caseosa – provides protection against bacteria Uneven coloring Bluish/grayish fingers, nose, feet
  39. 39. Assessing the Newborn/Neonate Apgar Scale (page 119) means:  Appearance (skin color)  Pulse (heart rate)  Grimace (reflex irritability)  Activity (muscle ton)  Respiration Newborn assessed using the APGAR scale approximately 1 to 5 minutes after delivery  Score  8 to 10 – big cry, adjust on their own  4 to 7 – need help, closely observed  0 to 3 – limp, unresponsive, NICU
  40. 40. Behavior of Newborn/Neonate Neonatal Behavioral Assessment Scale  Developed by T. Berry Brazelton  Measure newborn’s responses to the environment:  Reflexes  Motor Capabilities  Control attention  Behavior  Response to interactions with others
  41. 41. Some Terms: Preterm(premature)  Born prior to 37 weeks Low birthweight  Born after 37 weeks, less than 5 pounds  Lower the weights = more problems  Intelligence  Motor performance  Attention  Behavior
  42. 42. Neonatal Intensive Care Unit (NICU)  Mostpreterm newborns with developmental problems are placed in NICU  First step – warmth  All vitals monitored  2 to 9% newborns  Limited interaction with family  Encourage skin to skin contact

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