HS2700 Understanding Normal & In Utero - Birth PDF

  **Birth** - **Age of Viability**: 23 weeks in Ontario, 24 weeks in London - Chance of survival is low - Has been increasing due to precision medicine and technology - Increasing children with complex care conditions as age viability decreases -...

  **Birth** - **Age of Viability**: 23 weeks in Ontario, 24 weeks in London - Chance of survival is low - Has been increasing due to precision medicine and technology - Increasing children with complex care conditions as age viability decreases - Costs healthcare system a lot of money   **Preterm Birth** - Effects vary - Lifelong effects such as cerebral palsy, cognitive impairment, visual and hearing impairment, poor health and growth, behavioural and social-emotional problems   **LBW** - Negative effects on mental and motor development and growth at 9 months - 2 years - Effects on physical and mental development seem to lessen over time but growth effects do not - LBW = 5 lbs 8 ox - VLBW \< 3.9 lbs - ELBW \< 2.3 lbs - Normal = 5.8-8.23 lbs - Average BW in Canada = 8.7 lbs   **Birth Location** - 2 choices in London (both fully covered); A. Hospital - OB or midwife in birth suites B. Home - Midwife - 9% of first time moms, 21% of second time moms - Only offered to women with no risk factors and spontaneous labour - Low risk women have at least as good, if not better, outcomes than low risk women having hospital births - Less stressful, less possibility of infection, only low-risk babies   **APPROACHES TO CHILDBIRTH** +-----------------------------------+-----------------------------------+ | Method | Description | +===================================+===================================+ | **Lamaze Method** | - Teaching woman to be in | | | control in process of | | | delivery | | | | | | - Learning muscle relaxation, | | | breathing through | | | contractions, having a focal | | | point during contractions, | | | having a support person who | | | goes through the training | | | process | +-----------------------------------+-----------------------------------+ | **Leboyer Method** | - Giving birth in a quiet, | | | dimly lit room and allowing | | | newborn to lie of mother\'s | | | stomach with umbilical cord | | | intact for several minutes | | | while being given a warm bath | +-----------------------------------+-----------------------------------+ | **Dick-Read Method/Mongan | - Comes from suggestion that | | Method/Hypnobirthing** | the fear of childbirth | | | increasing tension and makes | | | process more painful | | | | | | - Emphasizes use of relaxation | | | and proper breathing with | | | contractions, and family | | | support | +-----------------------------------+-----------------------------------+ | **Bradley Method** | - Preparing mother for natural | | | childbirth coached by her | | | partner | +-----------------------------------+-----------------------------------+ | **Alexander Technique** | - Training to stop habitual | | | reactions to pain | | | | | | - Increase conscious awareness | | | and control over posture and | | | movement | | | | | | - Involves being able to move | | | freely and stay upright | | | during labour and using body | | | positioning that is | | | beneficial to labour process | +-----------------------------------+-----------------------------------+ | **Waterbirth** | - Immersion in water | +-----------------------------------+-----------------------------------+ | **Lotus Birth (Umbilical cord | - Leaving umbilical cord uncut | | nonseverance UCNS)** | after childbirth so baby is | | | left attached to placenta | | | until cord naturally | | | separates (usually 3-10 days | | | post birth) | | | | | | - Mainly for spiritual purposes | +-----------------------------------+-----------------------------------+ | **Silent Birth** | - Everyone attending birth | | | should refrain from spoken | | | words as much as possible | +-----------------------------------+-----------------------------------+ | **Medicated Childbirth** | - Medication to provide pain | | | relief | | | | | | - Includes epidurals, spinal | | | blocks, combined | | | spinal-epidurals, systemic | | | and local analgesia | | | | | | - 50% women giving birth at | | | hospital use epidural - | | | little to no effect on baby | | | | | | - Medications given through | | | injection can have negative | | | side effects on baby | +-----------------------------------+-----------------------------------+   **STAGES OF LABOUR** - Onset of labour - Mucus plug expulsion - Oxytocin production - Cervical stretching 1. Dilation - Muscles of uterus tighten (contract) and relax - Contractions help to thin (efface) and open (dilate) the cervix so baby can pass through birth canal - Longest stage 2. Birth - Cervix is completely dilated (10cm) and baby is born - Contractions every 2-3 mins 3. Afterbirth delivery - Contractions until placenta is delivered - Within 20 mins posy-delivery 4. Post-birth First few hours after birth (breastfeeding, hormone dump, may shake, feel cold, etc.)   **Medical Interventions in Childbirth** - Some babies go into fetal distress (sudden change in fetal hr) - First indication of issues = decceleration in fetal hr - Monitor unless need to do C-section - Anoxia (oxygen deprivation) can result in brain death or damage - Induction of labour due to mother approaching 2 weeks beyond due date, water broken but no contractions, baby stopped growing, not enough amniotic fluid surrounding baby, placenta peels away from inner wall of uterus, mother has medical condition - Cesarean Section - 1 in 3 - Relatively safe - Longer recovery - Incision may leave weak spot in wall of uterus - could cause problem with attempted vaginal birth later - Done when problems occur during delivery unexpectedely such as health problems in mother, signs of distress in baby, not enough room for baby to go through vagina, position of baby where head is not in downward position (ex. Breech)   **THE NEWBORN**   **Assessing the Newborn** - **Apgar Assessment:** Conducted 1 and 5 minutes post birth, assesses 5 measures: Heart rate, respiration, muscle tone, reflex response, colour - Receive score 0-2 on each features - Score of 5 or less is cause of concern - 2nd Apgar should show improvement - **Neonatal Behavioural Assessment Style (NBAS)**: Assesses motor development, muscle tone, stress response - Used to further assess newborn   **Problems of the Newborn** +-----------------------------------+-----------------------------------+ | **Anoxia**: Temporary lack of | - Can result in brain damage, | | oxygen to the brain | death, more likely to suffer | | | from learning disabilities | | | | | | - Caused by difficulty during | | | delivery | +===================================+===================================+ | **Low Birth Weight:** Child | - Difficulty maintaining body | | weighs less than 5 pounds 8 | temp (missing insulation), | | ounces | more risk for infection | | | | | | - VLBW (less than 2lbs) have | | | increased risk of developing | | | cerebral palsy | | | | | | - Many causes preventable with | | | proper prenatal care | +-----------------------------------+-----------------------------------+ | **Preterm:** Born at less than 37 | - Triggered by anything that | | weeks | disrupts mother\'s system | | | | | | - Can cause respiratory | | | distress syndrome, jaundice | | | | | | - Often can\'t regulate their | | | own temp/heart rate, can\'t | | | feed by nursing or bottle | | | | | | - Often require care in NICU | +-----------------------------------+-----------------------------------+ | **Small-for-date infants**: | - May be full or pre term | | Infants that have birth weights | | | below expectation based on their | - Growth was adversely | | gestational age | affected - very serious | | | | | | - Died at rates 4x higher than | | | other infants | +-----------------------------------+-----------------------------------+ | **Postmature**: Baby not born by | - Concerns about how long | | 42 weeks | placenta can function | | | | | | - Doctors consider induction | +-----------------------------------+-----------------------------------+ | **Stillborn:** Fetus dies while | - Causes unknown | | still inside mother (after 20-24 | | | weeks gestation) or dies during | | | delivery | | +-----------------------------------+-----------------------------------+   **Characteristics of the Newborn** - SIZE - loose 5% of body weight in first few days (temporary) - Followed by rapid period of growth - BODY PROPORTIONS - Head initially makes up 50% of entire length when developing - At birth, head makes up 25% of length - BRAIN DEVELOPMENT - brain is about 25% its adult weight, neurons not fully mature - APPEARANCE - **Lanugo:** Fine, downy body hair (normal and disappears) - Skull changes shape to fit birth canal (changes back) - Skin is grayish-dusky blue (returns to normal once baby starts breathing) - Scalp may be bruised/swollen - Wet, covered in streaks of blood, coated with Vernix (white substance) - May have Mongolian spots (blue or black birthmark on lower back) - Genitals enlarged and redden - Older babies look very different - SLEEP - 16.5 hrs/day in several periods - REFLEXES - Many - SENSORY - Visual - most poorly developed sense at birth - Hearing - ability to hear seen at 7th month of prenatal development, prefer infant-directed speech and mother\'s voice - TOUCH/PAIN - Sensitive to touch, temp, and pain immediately after birth - TASTE/SMELL - respond with different facial expressions (certain preferences are innate), can distinguish between sour bitter sweet salty (prefer sweet), show preference for mother\'s face