Prenatal Development And Birth Notes PDF

PRENATAL DEVELOPMENT AND BIRTH NOTES ==================================== 3.1 CONCEPTION -------------- Midway through the menstrual cycle, every 28 days or so, females ovulate: A follicle that has been growing inside the ovary erupts and releases an egg, thanks, in part, to follicle-stimulating h...

PRENATAL DEVELOPMENT AND BIRTH NOTES ==================================== 3.1 CONCEPTION -------------- Midway through the menstrual cycle, every 28 days or so, females ovulate: A follicle that has been growing inside the ovary erupts and releases an egg, thanks, in part, to follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Once released, the egg cell, called an ovum, begins its journey through the nearest fallopian tube to the uterus. Usually the egg disintegrates and leaves the body as part of the menstrual flow. However, if the woman has intercourse with a fertile man around the time of ovulation, one of his many sperm cells may penetrate the ovum on its descent from the ovary (Sadler, 2019). Once a single sperm penetrates the egg cell, a biochemical reaction occurs that repels other sperm and keeps them from entering the already fertilized egg. - Infertility---not being able to get pregnant after a year of trying---is equally likely to be traced to the man as to the woman and stems from a variety of causes such as: 1. Sexually transmitted diseases in both men and women 2. Varicocele- a condition in which enlarged veins on the testicles alters the temperature of the testes thus affecting sperm production 3. Problems with ovulation 4. Blocked fallopian tubes 5. Endometriosis- a condition arising when bits of tissue lining the uterus grow outside the uterus. - When simpler methods fail, some couples move on to more elaborate (and expensive) assisted reproductive technologies (ARTs), medical techniques used to increase fertility. - ART techniques typically start with or include prescription drugs to stimulate the woman's ovaries to ripen multiple follicles, leading to the release of several eggs. - If these techniques are unsuccessful couples may turn towards artificial insemination or in vitro fertilization (IVF) - ARTIFICIAL INSEMINATION: which involves injecting sperm, either from a woman's partner or from a donor, into her uterus - IVF- in which several eggs are removed from a woman's ovary and manually combined with sperm in a laboratory dish before being returned to the woman's uterus in hopes that one egg will implant on the uterine wall 3.1 PRENATAL STAGES ------------------- - It takes about 266 days, or roughly 9 months, for the zygote to become a fetus of billions of cells that is ready to be born - Experts called embryologists, who study early growth and development, divide prenatal development into three stages or periods: the germinal period, the embryonic period, and the fetal period. - GERMINAL PERIOD: A screenshot of a computer 1. Although estimates vary widely, somewhere between as few as 8% and as many as 50% of pregnancies are short-lived, ending in miscarriage (also called spontaneous abortion) before survival outside the womb is possible, with many of these losses occurring before the pregnancy has even been detected or before news of a pregnancy has been shared with friends and loved ones. - EMBRYONIC PERIOD (occurs from the 3^rd^ to 8^th^ week of conception)  1. During this short time, every major organ takes shape, in at least a primitive form, in a process called **organogenesis.** 2. The layers of the blastocyst differentiate, forming structures that sustain development. The outer layer becomes both the amnion, a watertight membrane that fills with fluid that cushions and protects the embryo, and the chorion, a membrane that surrounds the amnion and attaches rootlike extensions called villi to the uterine lining to gather nourishment for the embryo. 3. The chorion eventually becomes the lining of the placenta, a tissue fed by blood vessels from the mother and connected to the embryo by the umbilical cord. Through the placenta and umbilical cord, the embryo receives oxygen and nutrients from the mother and eliminates carbon dioxide and metabolic wastes into the mother's bloodstream. 4. Meanwhile, the cells in the interior of the blastocyst give rise to the ectoderm, mesoderm, and endoderm. These will eventually evolve into specific tissues and organ systems, including the central nervous system (brain and spinal cord) from the ectoderm; muscles, bones, cartilage, heart, arteries, kidneys, and gonads from the mesoderm; and gastrointestinal tract, lungs, and bladder from the endoderm. 5. In a small number of pregnancies, the neural tube fails to fully close. When this happens at the bottom of the tube, it can lead to spina bifida, in which part of the spinal cord is not fully encased in the protective covering of the spinal column. 6. Failure to close at the top of the neural tube can lead to anencephaly, a lethal defect in which the main portion of the brain above the brain stem fails to develop. 7. Development of vital organs such as the heart would be formed. Sexual differentiation also takes place at this stage. - FETAL PERIOD A screenshot of a computer Description automatically generated 1. This stage is a critical stage for brain development which involves three processes: PROLIFERATION, DIFFERENTIATION and MIGRATION. 2. PROLIFERATION: The proliferation of neurons involves their multiplying at a staggering rate during this period; by one estimate, the number of neurons increases by hundreds of thousands every minute throughout all of pregnancy, with a concentrated period of proliferation occurring between 6 and 17 weeks after conception. As a result the young infant has a 100 billion neurons. 3. MIGRATION: In migration, the neurons move from their place of origin in the center of the brain to particular locations throughout the brain where they will become part of specialized functioning units. Is influenced by the biochemical environment and the genetic instructions. 4. DIFFERENTIATION: Neurons may evolve into a particular type or function based on where they land following migration. Alternatively, another theory is that cells may "know" what they are supposed to be and where they are intended to go on their migratory path before reaching their final destination. 5. Organ systems that formed during the embryonic period continue to grow and begin to function. Harmful agents will no longer cause major malformations because organs have already formed, but they can stunt the growth of the fetus and interfere with the wiring of its rapidly developing nervous system. - The mother's womb is the prenatal environment for the unborn child. Just as children are influenced by their physical and social environments, so too is the fetus affected by its surroundings. - The physical environment includes everything from the molecules that reach the fetus's bloodstream before birth to the architecture of a home to the climate outside it. - The social environment includes all the people who can influence and be influenced by the developing person and the broader culture. - Research increasingly shows that events of the prenatal period can have lifelong effects on physical health and mental development. - The period of greatest environmental influence is during the prenatal period when growth and changes are occurring at an astonishingly fast rate. During this time, factors originating inside the mother, such as her hormone levels or immune system functioning, as well as factors originating outside the mother, such as exposure to pollution, can alter the expressionof genes throughout life. - A growing body of research indicates that developmental outcomes may be influenced by fetal programming brought about by such epigenetic effects of the environment. - The general idea of fetal programming is that environmental events and maternal conditions during pregnancy may alter the expected genetic unfolding of the embryo/fetus or reset its physiologic functions. As a result of these alterations, prenatal experience can change a person's physiology and the wiring of the brain and influence how the individual responds to postnatal events. - The offspring of the unborn child may also be affected. Through epigenetic codings carried on the DNA of the reproductive cells of the developing fetus, a pregnant woman's health, diet, and environment may adversely affect her future grandchildren. - According to research with animals and increasingly humans, prenatal imbalances in nutrition and exposure to environmental toxins may alter molecular pathways in ways. leading to disease and health challenges later in life. Adult health and mental health conditions such as obesity, heart disease, and schizophrenia may arise, in part, from the prenatal environment and fetal programming. - Unfortunately, adverse prenatal conditions such as poor nutrition and exposure to pollution disproportionately affect women---and their children---who live in poverty. The growing body of research showing lifelong effects of epigenetic processes helps contribute to our understanding of the oft-seen multigenerational impacts of poverty 3. TERATOGENS ---------- - A teratogen is any disease, drug, or other environmental agent that can harm a developing fetus (e.g., by causing deformities, blindness, brain damage, or even death). - Before considering the effects of some major teratogens, however, let us emphasize that only 15% of newborns have minor problems, and even fewer---perhaps 3%---have more significant anomalies due to teratogens. - Few generalizations about the effects of teratogens are: 1. Critical Period 2. Dosage and Duration 3. Genetic Makeup 4. Environment 1. ### DRUGS - Women from lower socioeconomic backgrounds are especially likely to take a prescription drug during the time they are pregnant, with antibiotics the most commonly prescribed drug - Under a doctor's close supervision, medications used to treat ailments and medical conditions are usually safe for mother and fetus. However, certain individuals exposed to certain drugs in certain doses at certain times during the prenatal period are affected for life. - THALIDOMIDE: 1. In the 1950s, this mild tranquilizer was widely used in Europe to relieve morning sickness (the periodic nausea and vomiting many women experience during pregnancy). Presumably, the drug was safe; tests showed that overdoses were not fatal. 2. Thousands of women who used thalidomide during the first 2 months of pregnancy gave birth to babies with all or parts of their limbs missing, with the feet or hands attached directly to the torso like flippers, or with deformed eyes, ears, noses, and hearts. 3. Thalidomide had been banned for years, but it is again being prescribed by physicians, this time for treatment of conditions associated with leprosy, acquired immunodeficiency syndrome (AIDS), tuberculosis, and some forms of cancer. - TOBACCO 1. During the first trimester, about 20% of mothers smoke, but by the third semester, this has dipped to about 12% of pregnant women, although there are considerable variations across different countries. 2. The effects of smoking during pregnancy are: Increased risk of miscarriage Prematurity, growth retardation, and small size Respiratory problems Cleft lip (an opening in the top lip) and cleft palate (an opening in the roof of the mouth) Problems with attention and impulsivity during childhood Problems with delinquent behavior and substance abuse from childhood into adulthood 3. The more a woman smokes during pregnancy, the more likely it is that her infant will experience growth retardation and neurological problems. 4. Heavier smoking is also associated with sudden infant death syndrome (SIDS), in which a sleeping baby suddenly stops breathing and dies. 5. Growing evidence suggests that genetic predisposition, environmental stressors, and a critical developmental period all interact to increase the risk of SIDS. 6. Smoking causes these effects by restricting blood flow to the fetus, which in turn reduces the levels of oxygen and nutrients that reach the fetus, leading to a variety of outcomes. 7. Cigarettes contain more than 4,000 other chemicals and smoking cigarettes produces carbon monoxide,which reduces the flow of blood and oxygen to the fetus. - ALCOHOL 1. Alcohol consumed by the mother readily crosses the placenta, where it can directly affect fetal development in various ways. Importantly, prenatal alcohol exposure disrupts the normal process of neuronal migration, leading to cells that do not end up at their proper final destination in the nervous system. 2. The most severe outcome of fetal alcohol exposure is a cluster of symptoms called fetal alcohol syndrome (FAS), with noticeable physical symptoms such as a small head and distinctive facial abnormalities including a thin upper lip, short nose, and flat midface. 3. Children with FAS are smaller and lighter than normal, and their physical growth lags behind that of their agemates. Most importantly, children with FAS also show signs of damage to the central nervous system. 4. Most children with FAS score well below average on IQ tests throughout childhood and adolescence, and many also exhibit hyperactive behavior and attention deficits. 5. Children who were exposed prenatally to alcohol but do not have FAS experience milder alcohol-related effects, part of a more general category of fetal alcohol spectrum disorders. These individuals do not have all the features of FAS but have physical, behavioral, or cognitive problems or a combination of these. 6. How much alcohol is consumed , the pattern of drinking and the period when consuming alcohol is important to understand. 7. The facial abnormalities associated with FAS results from consumption during the first trimester, more precisely the second half of the first trimester, when the face and skull bones are forming. 8. During the second and third trimesters, there is much fetal growth as well as rapid brain development; thus, alcohol consumption during this latter part of pregnancy is likely to stunt growth and brain development. Thus, there is no single critical period before or after which fetal alcohol effects cannot occur; drinking late in pregnancy can be as risky as drinking soon after conception. 9. The mother's physiology and how she efficiently metabolizes the alcohol can be one of the reasons why some mothers even when they drink during pregnancy their children do not experience any serious issues. 10. Combining alcohol use with other risky behaviors increases the odds of pregnancy complications. 11. In addition, consistent with the third principle of teratogenic effects, the embryo's genetic makeup and physical condition influence its ability to resist and recover from damage. 12. Fraternal twins are 64% concordant (i.e., matched) for signs of FAS, whereas identical twins are 100% concordant. Thus, for example, one fraternal twin may show all the physical abnormalities associated with FAS, but the other twin, although exposed to the same prenatal environment, may show almost none; by contrast, identical twins respond very similarly when exposed to alcohol prenatally. 13. the genetic makeup of the mother, the child, and, as we'll see in a later section, the father all interact with environmental forces to determine the effects of alcohol on development. - ILLICIT DRUGS 1. Cocaine is a strong stimulant and highly addictive. It readily crosses the placenta and constricts blood vessels, leading to slower or even blocked blood flow. This can cause spontaneous abortion in the first trimester of pregnancy and premature detachment of the placenta or fetal stroke later in pregnancy. 2. Cocaine also contributes to fetal malnourishment, restricted growth, and low birth weight. 3. At birth, a small proportion of babies born to cocaine users experience withdrawal-like symptoms such as tremors and extreme irritability and have respiratory difficulties. 4. Cocaine-exposed infants show increased activity levels as well as greater reactivity in response to stimulation during their first year. 5. Some of the consequences of prenatal cocaine exposure persist into adolescence, with higher rates of delinquent behavior and continued deficits on problem-solving and abstract-reasoning tasks. 6. In addition, cocaine-using mothers are less attentive to their babies and engage in fewer interactions with them during the first year than non--drug-using mothers or mothers who use drugs other than cocaine. 7. Opioid use has increased dramatically in recent years, quadrupling from 1999 to 2014 among women giving birth. Some opioids are medically prescribed to manage pain (e.g., OxyContin or Vicodin) but other opioids such as heroin are used illegally for recreational purposes. 8. Babies whose mothers used opioids during pregnancy tend to be smaller and are delivered earlier than other babies, often requiring a cesarean section delivery and respiratory support followingdelivery. 9. They may also suffer from neonatal abstinence syndrome (NAS) during the days and weeks following delivery as their bodies experience withdrawal from the drug. Symptoms include tremors, weight loss, feeding difficulties, irritability, seizures, and more, which often lead to extended stays in the hospital following birth. 10. Treatment for the affected infant includes swaddling and reduced stimulation to create a calm environment. When these methods don't work medication is used to ease the withdrawl symptoms.  ### 3.3.2 DISEASES AND INFECTIONS - RUBELLA 1. Rubella is most dangerous during the first trimester, a critical period in which the eyes, ears, heart, and brain are rapidly forming. 2. Nearly 25% of pregnant women with rubella miscarry or experience a fetal death and some may choose to terminate the pregnancy out of concern for harmful consequences of the virus on the developing fetus. 3. Birth defects occurs in 2/3rds of babies who mothers have had the disease in the first 2 months of pregnancy, in about half of those infected in the third month, and in relatively few of those infected in the fourth or fifth months. 4. Today, doctors stress that a woman should not try to become pregnant unless she has been immunized against rubella or has already had it. As a result of successful immunization programs, many women are now immune to this previously common infection. - DIABETES 1. Diabetes is a fairly common pregnancy complication, with most cases arising during pregnancy (gestational diabetes) rather than from preexisting diabetes. 2. Diabetes results from elevated blood glucose levels. When glucose levels are well controlled with diet, there are few ill effects on the developing fetus. But in poorly controlled maternal diabetes, there is increased risk of premature delivery, stillbirth or miscarriage, immature lung development, congenital heart defects, and neural tube defects. - SEXUALLY TRANSMITTED INFECTIONS 1. The sexually transmitted infection of greatest concern in recent decades is acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV). 2. AIDS destroys the immune system and makes victims susceptible to "opportunistic" infections that eventually kill them unless they are treated with multiple drugs. 3. HIV-infected mothers can transmit the virus to their babies: a. prenatally, if the virus passes through the placenta; b. perinatally, when blood may be exchanged between mother and child as the umbilical cord separates from the placenta; or c. postnatally, if the virus is transmitted during breastfeeding. 4. Somewhere between 15 and 45% of babies born to HIV- infected mothers will become infected. 5. The rate is much lower if the mothers are on antiretroviral drugs or their infants are given a drug called nevirapine which helps block HIV transmission at birth. 6. Syphilis during pregnancy can cause miscarriage or still birth in as many as 25% of cases where the mother is infected with syphilis and does not receive treatment. 7. Babies born alive to mothers who have syphilis and who do not receive treatment in a timely manner can eventually suffer from blindness, deafness, heart problems, or brain damage, like those babies born to mothers who have rubella. 8. Syphilis is most damaging in the middle and later stages of pregnancy. This is because syphilitic organisms cannot cross the placental barrier until the 18^th^ prenatal week, providing a window of opportunity for treating the mother-to-be who finds out she has the disease. 2. ### ENVIRONMENTAL HAZARDS - RADIATION: 1. Perhaps the most dramatic radiological event was when atomic bombs were dropped on Hiroshima and Nagasaki in 1945: Not one pregnant woman who was within one-half mile of the blasts gave birth to a live child, and 75% of those who were within a mile and a quarter of the blasts had stillborn infants or seriously handicapped infants who died soon after birth. 2. Surviving children of these mothers had a higher than-normal rate of intellectual disability and greater incidence of leukemia and cancers later in life. 3. The Chernobyl nuclear disaster in 1986 similarly led to increased congenital defects among infants born to women who were in the area of exposure. 4. Even across the Bay of Bothnia, in Sweden, women who were pregnant during the fallout from the Chernobyl accident experienced higher rates of congenital abnormalities among their babies despite much lower levels of radiation exposure. 5. Timing of radiation as well as dosage of radiation is important to know to understand the serious implications radiation can have on a developing fetus. 6. Therefore, expectant mothers are routinely advised to avoid X-rays or radiation unless they are essential to their own survival, as might be the case with women undergoing certain cancer treatments. - POLLUTANTS: 1. Studies consistently show a connection between the by-products of pollution, measured in maternal blood and umbilical cord blood collected at birth, and such birth complications as prematurity and low birth weight. 2. It is important to note that those children who were exposed to multiple risk factors in utero experienced more problems than those exposed to a single factor. 3. Thus, with good postnatal care, children might overcome negative consequences of prenatal exposure to pollution or to cigarette smoke but overcoming multiple risk factors is more of a challenge. 4. Prenatal exposure to pesticides, dioxins, and polychlorinated biphenyls (PCBs) has also been associated with perinatal and postnatal problems. 5. The chemistry of the prenatal environment often determines whether an embryo or fetus survives and how it looks and functions after birth. 4. MATERNAL FACTORS ---------------- 3. ### AGE AND RACE/ETHNICITY - Very young mothers have higher-than-normal rates of birth complications, including premature deliveries and stillbirths---fetal deaths late in pregnancy (20 or more weeks gestational age). - The reproductive system of a teenager (19 years or younger) may not be physically mature enough to sustain a fetus to full term, making this group more susceptible to mild preeclampsia. - Older women are more likely to experience difficulty in getting pregnant. - In the past, many fetal deaths in older women were caused by genetic abnormalities or defects arising during the first weeks after conception,when the major organs are forming. - Most notable is that non-Hispanic black women have fetal mortality rates that are more than twice the rates experienced by other women. The reasons for this disparity are not completely understood but include poorer preconception health of the mother and less prenatal care. 4. ### NUTRITIONAL CONDITION - Most women gain between 25 and 35 pounds (about 11 to 16 kg) during pregnancy and consume up to 450 additional calories in the third trimester when the fetus is gaining most of its weight. Women who practice healthy eating habits during pregnancy lower the risk of having a small-for-date infant - Several nutrients are especially important during pregnancy such as folate, calcium, vitamin d etc. Consequently, most health-care professionals prescribe prenatal vitamins for their pregnant patients. - During the first trimester, malnutrition can disrupt the formation of the spinal cord, result in fewer brain cells, and even cause stillbirth. The offspring of malnourished mothers sometimes show cognitive deficits as infants and children. Through fetal programming, poor prenatal nutrition may also put some children at risk for certain diseases in adulthood, including hypertension, coronary heart disease, diabetes, and even the serious mental disorder schizophrenia. - Maternal obesity, as well as excessive weight gain during pregnancy, is associated with offspring obesity and diabetes. - Prenatal environmental conditions as well as preconception conditions of the parents help to build the architecture of the developing fetus and set the stage for how its body will react and respond to events postnatally. 5. ### EMOTIONAL CONDITION - When a woman becomes emotionally aroused, her glands secrete powerful hormones such as adrenaline (also called epinephrine) that can cross the placental barrier and enter the fetus's bloodstream. - The most immediate effects of prolonged stress of the mother on the fetus are a faster and more irregular heart rate and stunted prenatal growth, which can lower birth weight, cause premature birth, and lead to birth complications. Following birth, babies whose mothers had been highly stressed during pregnancy tend to be smaller, more active, more irritable, and more prone to crying than other babies. - They may experience delays in cognitive development, exhibit greater fearfulness as young children, and have higher rates of depression at age 11. - Finally, severe maternal stress during the first trimester has been linked to an increased likelihood of developing schizophrenia, a serious mental disorder whose symptoms typically emerge in adolescence or early adulthood. - Stress elevates levels of maternal cortisol, which crosses the placenta and influences, or sensitizes, developing fetal "stress" receptors in the brain. - After birth, when a prenatally stressed infant is exposed to stressful events, their prenatally sensitized nervous system is more reactive, leading to poor stress regulation. - Depression during pregnancy poses a challenge for women and their physicians because, left untreated, depression can affect fetal development, but some treatments for depression, namely prescription antidepressant medication, have also been found to negatively influence prenatal development. 5. PATERNAL FACTORS ---------------- - Children born to older fathers also face elevated risk of congenital heart defects, neural tube defects, and kidney problems, as well as preterm delivery and low birth weight. - Like the risk of miscarriage, the odds of Down syndrome and genetic conditions caused by mutations are greater when both mother and father are older. - As well, the offspring of young fathers (less than 20 years) are at greater risk for Down syndrome and some other anomalies. Finally, researchers have consistently identified advanced paternal age (i.e., 50 and older) as a risk factor for schizophrenia. - Some research suggests that a father's use of alcohol can influence fetal development through transmission of the father's genes to his offspring. - Fathers who use or abuse alcohol may have parenting styles that differ from those of fathers who do not use or abuse alcohol. - A father's exposure to environmental toxins can also affect a couple's children. A father's prolonged exposure to radiation, anesthetic gases used in operating rooms, pesticides, or other environmental toxins can damage the genetic material in his sperm and cause genetic defects in his children. 6. PERINATAL ENVIRONMENT --------------------- - The perinatal environment is the environment surrounding birth; it includes influences such as drugs given to the mother during labor, delivery practices, and the social environment shortly after birth. The perinatal environment is also influenced by a woman's beliefs about labor and delivery, which can have a positive or negative affect on her birth experience. - This change in birth setting was accompanied by a shift from thinking about birth as a natural family event that occurred at home to thinking about it as a medical problem to be solved with high technology. - Mothers-to-be have several choices when it comes to who will assist with their delivery, including family physicians, obstetricians, specialists in maternal--fetal medicine, and midwives. - Clearly, then, the social context surrounding labor and delivery is important: Women who receive more support during childbirth have more positive experiences. 7. CHILDBIRTH ---------- - Childbirth is a three stage process: 1. The first stage of labor begins as the mother experiences regular contractions of the uterus and ends when her cervix has fully dilated (widened) so that the fetus's head can pass through. d. Approximately one-third of laboring women receive some assistance withthis stage, usually the administration of oxytocin (brand name Pitocin), a hormone released by the pituitary gland that can initiate and speed up contractions, moving labor along more quickly. 2. The second stage of labor is delivery, which begins as the fetus's head passes through the cervix into the vagina and ends when the baby emerges from the mother's body. 3. Finally, the third stage of the birth process is the delivery of the placenta, which lasts only a few minutes. 8. POSSIBLE HAZARDS ---------------- - ANOXIA: Is oxygen shortage. Anoxia is dangerous primarily because brain cells die if they are starved of oxygen for more than a few minutes. In the long run, severe anoxia can lead to cerebral palsy, a neurological disability primarily associated with difficulty controlling muscle movements; it also increases the risk of learning or intellectual disabilities and speech difficulties. - COMPLICATED DELIVERY: mothers may need assistance with delivery, possibly because labor has proceeded too long with little progress or because of concern about the well-being of the baby or mother. Examples forceps, suction, cesarean birth etc. - MEDICATIONS: Today, the most common pain relief is an epidural block, which is administered through an injection or tube in the lower back. The medication reduces awareness of pain and sensation in specific parts of the body and is considered relatively safe for the baby. Alternative methods for controlling pain, such as systematic relaxation techniques, can be successful, but are not regularly offered and require more time from someone trained in these techniques than administering medication for pain control. 9. THE MOTHER'S EXPERIENCE ----------------------- - Psychological factors such as the mother's attitude toward her pregnancy, her knowledge and expectations about the birth process, her sense of control over childbirth, and the social support she receives from her partner or someone else are important determinants of her experience of delivery and of her new baby. - Not surprisingly, women report a more negative birth experience when their newborn seems to be struggling immediately after birth, even when the infant quickly rebounds, women who labor longer report more negative feelings about the birth experience, especially when active labor is prolonged. 1. ### CULTURAL FACTORS - The experience of childbearing is shaped by the cultural context in which it occurs. For example, different cultures have different views of the desirability of having children. - Practices surrounding birth also differ widely. - In addition to different cultural influences on childbirth practices, cultural beliefs influence behaviors during the postpartum period. In some cultures, women's activities and interactions with others are restricted for a period of time following childbirth. 2. ### POSTPARTUM DEPRESSION - Some new mothers suffer from depression following the birth of their baby. Many new mothers report feeling tearful, irritable, moody, anxious, and depressed within the first few days after birth. This condition is know as the baby blues. - A second, and far more serious, condition is postpartum depression---an episode of clinical depression lasting 2 or more weeks (rather than days) in a woman who has just given birth. It affects approximately 15--20% of new mothers. - A second, and far more serious, condition is postpartum depression---an episode of clinical depression lasting 2 or more weeks (rather than days) in a woman who has just given birth. It affects approximately 15--20% of new mothers. Lack of social support---especially a poor relationship with a partner---also increases the odds. 10. PARTNER'S EXPERIENCE -------------------- - Today, many men prepare for fatherhood before delivery, attend prenatal classes with their partner, and are present for their child's birth. Fathers and partners report that they want to be involved with their partner's pregnancy, although they don't always know how to make this happen. - Stress levels among men tend to be highest during their partner's pregnancy and then decrease after the birth of the baby. Despite the stresses, negative emotions usually give way to relief, pride, and joy when the baby finally arrives. - Also like mothers, fathers tend to be anxious during pregnancy and birth and some even experience some of the same physiological symptoms as their pregnant partner, feeling fatigued, bloated, and even nauseous. These symptoms may be influenced by the decline in testosterone that men experience during their partner's pregnancy. 11. NEONATAL ENVIRONMENT -------------------- - The neonatal environment---the events of the first month and how parents might optimize the development of young infants. - There are marked differences in how parents interact with their newborns. As Meredith Small (1999) characterizes it, "Our ideas about parenting and infant care are as culturally constructed as what we wear, what we eat, or how we dance". For example, in societies where infant mortality is high, babies may not even be named or viewed as people until they seem likely to survive. 12. IDENTIFYING AND ASSESSING AT RISK BABIES ---------------------------------------- - Newborns are routinely screened using the Apgar test, which provides a quick assessment of the newborn's heart rate, respiration, color, muscle tone, and reflexes. - One particular group of at-risk babies that should be examined more closely are those with low birth weight (LBW). Although LBW infants account for about 9% of all births, they account for about two-thirds of all infant deaths and nearly 60% of the money spent on pregnancies and deliveries. - We don't always know what causes LBW, but research has identified a number of factors regularly associated with it, including: Age of mother (very young or older) Low socioeconomic status of mother, linked with poor nutrition and inadequate prenatal care Race (black women are twice as likely as white women to experience premature delivery) Prior premature deliveries, which may indicate underlying and persistent health conditions Tobacco or alcohol use Stress Pregnancies with more than one fetus (twins, triplets, etc.) Infections High blood pressure. - However, compared with normal-birth-weight children, LBW children, especially those with extremely LBW, are at greater risk for numerous neurobehavioral problems, including blindness, deafness, cerebral palsy, poor academic achievement, autism, and health problems. - Respiratory difficulties are likely because premature babies have not yet produced enough surfactant, a substance that prevents the air sacs of the lungs from sticking together and therefore aids breathing. - In addition to the advances made thanks to the high-tech interventions now available in most neonatal intensive care units (NICUs), research has shown that several low-tech interventions can go far in improving the developmental outcomes of LBW, premature infants such as the mother's breast milk. - There is also evidence that skin-to-skin contact is therapeutic for these infants. Sometimes called kangaroo care, resting on a parent's chest helps maintain body temperature, heart rate, and oxygen levels in the blood (Conde-Agudelo et al., 2011) and the rhythmic sound of the parent's heartbeat calms the infant and may help simulate the environment of the womb. - In addition to skin-to-skin contact, Tiffany Field and her colleagues have shown that premature infants benefit from massage therapy. Those who received moderate-pressure massage gained significantly more weight on each of the days of the therapy than the premature babies in the light-massage group. Babies receiving moderate massage seemed to be more relaxed and less aroused, which may have facilitated greater weight gain. - The fate of premature and LBW babies depends considerably on two factors. The first is their biological condition---their health and neurological status in particular. The second is the quality of the postnatal environment they experience. 13. RISK AND RESILIENCE ------------------- - The effects of prenatal and perinatal complications decrease over time and the outcomes of early risk depend on the quality of the postnatal environment. - The successful at-risk children benefitted from two types of protective factors, influences that prevent the damaging effects of risk factors or help children overcome disadvantages. These are: 1. PERSONAL RESOURCES: Possibly because of their genetic makeup, some children have qualities such as intelligence, sociability, and communication skills that help them choose or create more nurturing and stimulating environments and cope with challenges. 2. SUPPORTIVE POSTNATAL ENVIRONMENT: Some at-risk children receive the social support they need within or outside the family. Most importantly, they are able to find at least one person who loves them unconditionally and with whom they feel secure.