Prenatal Development and Birth - Chapter 3 PDF

86 PART 1 Beginnings LO 2.15 Describe the challenges that relate to pregnancy. Some couples need medical aid to help them conceive. Among the alternate routes to conception are artificial insemination and in vitro fertilization (IVF). Some women may also experience miscarriage or opt for an abortion...

86 PART 1 Beginnings LO 2.15 Describe the challenges that relate to pregnancy. Some couples need medical aid to help them conceive. Among the alternate routes to conception are artificial insemination and in vitro fertilization (IVF). Some women may also experience miscarriage or opt for an abortion. LO 2.16 Describe the threats to the fetal environment and what can be done about them. A teratogen is an environmental agent such as a drug, chemical, virus, or other factor that produces a birth defect. The diet, age, prenatal support, and illnesses of mothers can affect their babies’ health and growth. Mothers’ use of drugs, alcohol, tobacco, and caffeine can adversely affect the health and development of the unborn child. Fathers’ and others’ behaviors (e.g., smoking) can also affect the health of the unborn child. Journal Prompt Applying Lifespan Development: Studies show that “crack babies” who are entering school have significant difficulty dealing with multiple stimuli and forming close attachments. How might both genetic and environmental influences have combined to produce these results? Epilogue In this chapter, we have discussed the basics of heredity and genetics, including the way in which the code of life is transmitted across generations through DNA. We have also seen how genetic transmission can go wrong, and we have discussed ways in which genetic disorders can be treated— and perhaps prevented—through new interventions such as genetic counseling. One important theme in this chapter has been the interaction between hereditary and environmental factors in determining a number of human traits. Although we have encountered a number of surprising instances in which heredity plays a part—including in the development of personality traits and even personal preferences and tastes—we have also seen that heredity is virtually never the sole factor in any complex trait. Environment nearly always plays an important role. Finally, we reviewed the main stages of prenatal growth—germinal, embryonic, and fetal—and examined threats to the prenatal environment and ways to optimize that environment for the fetus. Before moving on, return to the prologue of this chapter and the case of the Chens’ son, who was treated for spina bifida before he even was born. Answer the following questions based on your understanding of genetics and prenatal development. 1. Do you believe that the Chens made the correct decision in permitting their son to be operated on in utero rather than waiting until after his birth? Why? 2. Research suggests that insufficient folic acid in the mother’s diet contributes to incidents of spina bifida in offspring. Do you see this as a genetic or an environmental factor? Explain your thinking. 3. What kind of evidence would suggest whether or not spina bifida is an X-linked recessive disorder? 4. If it had not been possible to perform fetal surgery on the Chens’ son, what do you think the best course of action would have been for his parents? Looking Back LO 2.1 Describe how genes and chromosomes provide our basic genetic endowment. A child receives 23 chromosomes from each parent. These 46 chromosomes provide the genetic blueprint that will guide cell activity for the rest of the individual’s life. LO 2.2 Compare monozygotic twins with dizygotic twins. Monozygotic twins are twins who are genetically identical. Dizygotic twins result from two separate ova fertilized by two separate sperm at roughly the same time. LO 2.3 Describe how the sex of a child is determined. When an ovum and a sperm meet at the moment of fertilization, the ovum provides an X chromosome, and the sperm provides either an X or a Y chromosome. If the sperm contributes its X chromosome, the child will have an XX pairing—a female. If the sperm contributes a Y chromosome, the result will be an XY pairing—a male. for more ebook/ testbank/ solution manuals requests: LO 2.4 Explain the mechanisms by which genes transmit information. A genotype is the underlying combination of genetic material present in an organism but invisible; a phenotype is the visible trait, the expression of the genotype. LO 2.5 Describe the field of behavioral genetics. The field of behavioral genetics, a combination of psychology and genetics, studies the effects of genetics on behavior and psychological characteristics. LO 2.6 Describe the major inherited disorders produced by damaged or mutated genes. Genes may become physically damaged or may spontaneously mutate. If damaged genes are passed on to the child, the result can be a genetic disorder. LO 2.7 Describe the role of genetic counselors and differentiate between different forms of prenatal testing. Genetic counselors use a variety of data and techniques to advise future parents of possible genetic risks to their unborn children. A variety of techniques can be used to assess the health of an unborn child if a woman is already pregnant, including ultrasound, CVS, and amniocentesis. LO 2.8 Explain how the environment and genetics work together to determine human characteristics. Behavioral characteristics are often determined by a combination of genetics and environment. Genetically based traits represent a potential, called the genotype, which may be affected by the environment and is ultimately expressed in the phenotype. LO 2.9 Summarize how researchers study the interaction of genetic and environmental factors in development. To work out the different influences of heredity and environment, researchers use nonhuman studies and human studies, particularly of twins. LO 2.10 Explain how genetics and the environment jointly influence physical traits, intelligence, and personality. Virtually all human traits, characteristics, and behaviors are the result of the combination and interaction of nature and nurture. Many physical characteristics show strong genetic influences. Intelligence contains a strong genetic component but can be significantly influenced by environmental factors. Some personality traits, including neuroticism and extroversion, have been linked to genetic factors, and even attitudes, values, and interests have a genetic component. Some personal behaviors may be genetically influenced through the mediation of inherited personality traits. email Chapter 2 [email protected] The Start of Life: Prenatal Development 87 LO 2.11 Explain the role genetics and the environment play in the development of psychological disorders. Certain psychological disorders, such as schizophrenia, are largely caused by genetics. Other disorders, including alcoholism and major depressive disorder, have both genetic and environmental causes. LO 2.12 Describe ways in which genes influence the environment. Children may influence their environment through genetic traits that cause them to construct—or influence their parents to construct—an environment that matches their inherited dispositions and preferences. LO 2.13 Explain the process of fertilization. When sperm enter the vagina, they begin a journey that takes them through the cervix, the opening of the uterus, and into the fallopian tubes, where fertilization may take place. Fertilization joins the sperm and ovum to start prenatal development. LO 2.14 Summarize the three stages of prenatal development. The germinal stage (fertilization to 2 weeks) is marked by rapid cell division and specialization, and the attachment of the zygote to the wall of the uterus. During the embryonic stage (2 to 8 weeks), the ectoderm, the mesoderm, and the endoderm begin to grow and specialize. The fetal stage (8 weeks to birth) is characterized by a rapid increase in complexity and differentiation of the organs. The fetus becomes active, and most of its systems become operational. LO 2.15 Describe the challenges that relate to pregnancy. Some couples need medical aid to help them conceive. Among the alternate routes to conception are artificial insemination and in vitro fertilization (IVF). Some women may also experience miscarriage or opt for an abortion. LO 2.16 Describe the threats to the fetal environment and what can be done about them. A teratogen is an environmental agent such as a drug, chemical, virus, or other factor that produces a birth defect. Factors in the mother that may affect the unborn child include diet, age, illnesses, and drug, alcohol, and tobacco use. The behaviors of fathers and others in the environment may also affect the health and development of the unborn child. 88 PART 1 Beginnings Key Terms and Concepts zygote 49 genes 49 DNA (deoxyribonucleic acid) molecules 49 chromosomes 49 monozygotic twins 50 dizygotic twins 50 dominant trait 52 recessive trait 52 genotype 52 phenotype 52 homozygous 52 heterozygous 52 polygenic inheritance 53 X-linked genes 54 behavioral genetics 55 Down syndrome 56 fragile X syndrome 57 sickle-cell anemia 57 Tay-Sachs disease 57 Klinefelter’s syndrome 57 genetic counseling 58 ultrasound sonography 59 chorionic villus sampling (CVS) amniocentesis 59 temperament 62 multifactorial transmission 62 fertilization 73 59 germinal stage 74 placenta 74 embryonic stage 74 fetal stage 75 fetus 75 infertility 76 assisted reproductive technology (ART) 77 artificial insemination 77 in vitro fertilization (IVF) 77 teratogen 79 fetal alcohol spectrum disorder (FASD) 83 fetal alcohol effects (FAE) 83 for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Photobac/Shutterstock Birth and the Newborn Infant Learning Objectives LO 3.1 Describe the normal process of labor. LO 3.7 LO 3.2 Explain the events that occur in the first few hours of a newborn’s life. Describe rates of infant mortality and what factors affect these statistics. LO 3.8 Describe some of the current approaches to childbirth. Describe the causes and effects of postpartum depression. LO 3.9 Describe some of the causes of, effects of, and treatments for preterm births. Describe the physical capabilities of the newborn. LO 3.10 Describe the sensory capabilities of the Identify the risks that postmature babies face. LO 3.11 Describe the learning capabilities of the Describe the process of cesarean delivery and the reasons for its increase in use. LO 3.12 Describe the social competencies of LO 3.3 LO 3.4 LO 3.5 LO 3.6 newborn. newborn. newborns. 89 90 PART 1 Beginnings Chapter Overview Birth Stillbirth and Infant Mortality: The Tragedy of Premature Death Labor: The Process of Birth Begins Postpartum Depression: Moving from the Heights of Joy to the Depths of Despair Birth: From Fetus to Neonate Approaches to Childbirth: Where Medicine and Attitudes Meet The Competent Newborn Birth Complications Preterm Infants: Too Soon, Too Small Physical Competence: Meeting the Demands of a New Environment Postmature Babies: Later, Larger Sensory Capabilities: Experiencing the World Cesarean Delivery: Intervening in the Process of Birth Social Competence: Responding to Others Early Learning Capabilities Prologue: Birth in the Age of COVID-19 The doctors were extremely worried. It was too soon for Precious Anderson, age 31, to give birth because she was only 7 months pregnant. And if the baby were to be delivered now, 2 months early, it would have immediate problems breathing and eating and would be at risk for potentially lifelong problems. Yet there seemed to be little choice. Anderson, a substitute teacher, was suffering from a coronavirus infection, one more victim of the worldwide pandemic that started in 2020. She was clinging to life, and her lungs were barely functioning. Her only hope, the doctors believed, would be delivering the baby immediately, which might reduce the pressure on her body and help her survive. So doctors carried out an emergency cesarean delivery, itself risky for a woman in such poor health. But the result was a ray of light during the pandemic: Both mother and baby— named David, after his father—survived and were recovering (Fink, 2020). Shutterstock Looking Ahead Infants were not meant to be born as early as David and not to a mother who was sick with a virus that ravaged and killed millions of people across the globe. Yet, miraculously, both were kept alive by a combination of extraordinary medical care and an inborn will to live. All births are tinged with a combination of excitement and some degree of anxiety. In the vast majority of cases, however, delivery goes smoothly, and it is an amazing and joyous moment when a new being enters the world. The excitement of birth is soon replaced by wonder at the extraordinary nature of newborns themselves. Babies enter the world with a surprising array of capabilities, ready from the first moments of life outside the womb to respond to the world and the people in it. In this chapter, we’ll examine the events that lead to the delivery and birth of a child and take an initial look at the newborn. We first consider labor and delivery, exploring how the process usually proceeds, as well as several alternative approaches. We next examine some of the possible complications of birth. The problems that can occur range from premature births to infant mortality. Finally, we consider the extraordinary range of capabilities of newborns. We’ll look not only at their physical and perceptual abilities, but at the way they enter the world with the ability to learn and with skills that help form the foundations of their future relationships with others. for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 91 Birth I wasn’t completely naïve. I mean, I knew that it was only in movies that babies come out of the womb all pink, dry, and beautiful. But still, I was initially taken aback by my son’s appearance. Because of his passage through the birth canal, his head was cone-shaped, a bit like a wet, partly deflated football. The nurse must have noticed my reaction because she hastened to assure me that all this would change in a matter of days. She then moved quickly to wipe off the whitish sticky substance all over his body, informing me as she did so that the fuzzy hair on his ears was only temporary. I leaned in and put my finger into my boy’s hand. He rewarded me by closing his hand around it. I interrupted the nurse’s assurances. “Don’t worry,” I stammered, tears suddenly filling my eyes. “He’s absolutely the most beautiful thing I’ve ever seen.” For those of us accustomed to thinking of newborns in the images of baby food commercials, this portrait of a typical newborn may be surprising. Yet most babies come out of the womb resembling this one. Make no mistake, however: Despite their temporary blemishes, babies are a welcome sight to their parents from the moment of their birth. The newborn’s outward appearance is caused by a variety of factors in its journey from the mother’s uterus, down the birth canal, and out into the world. We can trace its passage, beginning with the release of the chemicals that initiate the process of labor. Labor: The Process of Birth Begins Describe the normal process of labor. About 266 days after conception, a protein called corticotropin-releasing hormone (CRH) triggers (for some still unknown reason) the release of various hormones, and the process that leads to birth begins. One critical hormone is oxytocin, which is released by the mother’s pituitary gland. When the concentration of oxytocin becomes high enough, the mother’s uterus begins periodic contractions (Terzidou, 2007; Tattersall et al., 2012; Gordon et al., 2017; Maeder et al., 2020). During the prenatal period, the uterus, which is composed of muscle tissue, slowly expands as the fetus grows. Although for most of the pregnancy it is inactive, after the fourth month it occasionally contracts to ready itself for the eventual delivery. These Braxton–Hicks contractions are sometimes called “false labor” because although they can fool eager and anxious expectant parents, they do not signify that the baby will be born soon. When birth is actually imminent, the uterus begins to contract intermittently. The increasingly intense contractions make the uterus act like a vise, opening and closing to force the head of the fetus against the cervix, the neck of the uterus that separates it from the vagina. Eventually, the force of the contractions becomes strong enough to propel the fetus slowly down the birth canal until it enters the world as a neonate—the term used neonates for a newborn. It is this exertion and the narrow birth passage that often give newborns the term used for newborns the battered, cone-head appearance described earlier. Labor proceeds in three stages (see Figure 3-1). In the first stage of labor, the uterine contractions initially occur around every 8 to 10 minutes and last about 30 seconds. As labor proceeds, the contractions occur more frequently and last longer. Toward the end of labor, the contractions may occur every 2 minutes and last almost 2 minutes. During the final part of the first stage of labor, a period known as transition, the contractions increase to their greatest intensity. The mother’s cervix fully opens, eventually expanding enough (usually to around 10 centimeters) to allow the baby’s head (the widest part of the body) to pass through. Labor can be exhausting and seems never-ending, but support, This first stage of labor is the longest. Its duration varies communication, and a willingness to try different techniques significantly, depending on the mother’s age, race, ethnicity, can all be helpful. Gorodenkoff/Shutterstock LO 3.1 92 PART 1 Beginnings Figure 3-1 The Three Stages of Labor Stage 1 Stage 2 Stage 3 Umbilical cord Uterus Placenta Uterine contractions initially occur every 8 to 10 minutes and last 30 seconds. Toward the end of labor, contractions may occur every 2 minutes and last as long as 2 minutes. As the contractions increase, the cervix, which separates the uterus from the vagina, becomes wider, eventually expanding to allow the baby’s head to pass through. episiotomy an incision sometimes made to increase the size of the opening of the vagina to allow the baby to pass Placenta Cervix The baby’s head starts to move through the cervix and birth canal. Typically lasting around 90 minutes, the second stage ends when the baby has completely left the mother’s body. The child’s umbilical cord (still attached to the neonate) and the placenta are expelled from the mother. This stage is the quickest and easiest, taking just a few minutes. number of prior pregnancies, and a variety of other factors involving both the fetus and the mother. Typically, labor takes 16 to 24 hours for firstborn children, but there are wide variations. Births of subsequent children usually involve shorter periods of labor. During the second stage of labor, which typically lasts around 90 minutes, the baby’s head emerges further from the mother with each contraction, increasing the size of the vaginal opening. Because the area between the vagina and rectum must stretch a good deal, an incision called an episiotomy is sometimes made to increase the size of the opening of the vagina. However, this practice has been increasingly criticized in recent years as potentially harmful due to risks including the potential of infection and long-term pain and the American Academy of Obstetricians and Gynecologists recommends against the routine use of episiotomies. Whether or not an episiotomy is used, the second stage of labor ends when the baby has completely left the mother’s body (Ballesteros-Meseguer, 2016; Aguiar et al., 2019; Molyneux et al., 2021). Finally, the third stage of labor occurs when the child’s umbilical cord (still attached to the neonate) and the placenta are expelled from the mother. This stage is the quickest and easiest, taking just a few minutes. There is a kernel of truth to popular stories of pregnant women in certain societies putting down the tools with which they are tilling their fields, stepping aside and giving birth, and immediately returning to work with their neonates wrapped and bundled on their backs. Accounts of the !Kung people in Africa describe the woman in labor sitting calmly beside a tree and without much ado—or assistance—giving birth to a child and quickly recovering. Furthermore, in some Asian cultures, the way in which a woman handles labor reflects on her family’s honor; an inability to accept labor and childbirth stoically can be seen as bringing shame to the family (Callister et al., 2003; Christiaens et al., 2010; Mathur et al., 2020). By contrast, many societies regard childbirth as dangerous, and some even view it in terms befitting an illness. Such cultural perspectives color the way that people in a given society view the experience and expectations about dealing with childbirth, as we discuss in Development in Your Life. for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 93 Development in Your Life Dealing with Labor Every woman who is soon to give birth has some fear of labor. worst of the pain is going to last only another 20 minutes or so, you may feel you can handle it. Most have heard gripping tales of extended, 48-hour labors or vivid descriptions of the pain that accompanies labor. Still, few Remember that labor is... laborious. Expect that you may become fatigued, but realize that as the final stages of labor occur, you may well get a second wind. Accept your partner’s support. If a spouse or other partner is present, allow that person to make you comfortable and provide support. Research has shown that women who are supported by a spouse or partner have a more comfortable birth experience (Uluğ & Öztürk, 2020). Be realistic and honest about your reactions to pain. Even if you had planned an unmedicated delivery, realize that you may find the pain difficult to tolerate. At that point, consider the use of drugs. Above all, don’t feel that asking for pain medication is a sign of failure. It isn’t (Gibson, 2021). Focus on the big picture. Keep in mind that labor is part of a process that ultimately leads to an event unmatched in the joy it can bring. mothers would dispute the notion that the rewards of giving birth are worth the effort. There is no single right or wrong way to deal with labor. However, several strategies can help make the process as positive as possible: Be flexible. Although you may have carefully worked out what to do during labor, don’t feel an obligation to follow through exactly. If a strategy is ineffective, turn to another one. Communicate with your health care providers. Let them know what you are experiencing. They may be able to suggest ways to deal with what you are encountering. As your labor progresses, they may also be able to give you a fairly clear idea of how much longer you will be in labor. Knowing the Birth: From Fetus to Neonate LO 3.2 Explain the events that occur in the first few hours of a newborn’s life. The exact moment of birth occurs when the fetus, having left the uterus through the cervix, passes through the vagina to emerge fully from its mother’s body. In most cases, babies automatically make the transition from taking in oxygen via the placenta to using their lungs to breathe air. Consequently, as soon as they are outside the mother’s body, most newborns spontaneously cry. This helps them clear their lungs and breathe on their own. What happens next varies from situation to situation and from culture to culture. In Western cultures, health care workers are almost always on hand to assist with the birth. In North America, 99 percent of births are attended by skilled health personnel, but in the least developed countries, 66 percent of births have skilled health personnel in attendance (UNICEF and World Health Organization, 2021). In most cases, the newborn infant first undergoes a quick visual inspection. Parents may be counting fingers and toes, but trained health care workers look for something more. Typically, they employ the Apgar scale, a standard measurement system that looks for a variety of indications of good health (see Table 3-1). THE APGAR SCALE. Table 3-1 Apgar Scale A score is given for each sign at 1 minute and 5 minutes after the birth. If there are problems with the baby, an additional score is given at 10 minutes. A score of 7 to 10 is considered normal, whereas 4 to 7 might require some resuscitative measures, and a baby with an Apgar score less than 4 requires immediate resuscitation. Sign 0 Points 1 Point 2 Points A Appearance (skin color) Blue-gray, pale all over Normal, except for extremities Normal over entire body P Pulse Absent Below 100 bpm Above 100 bpm G Grimace (reflex irritability) No response Grimaces Sneezes, coughs, pulls away A Activity (muscle tone) Absent Arms and legs flex Active movement R Respiration Absent Slow, irregular Good, crying (Source: Apgar, 1953.) Apgar scale a standard measurement system that looks for a variety of indications of good health in newborns 94 PART 1 Beginnings anoxia a restriction of oxygen to the baby, lasting a few minutes during the birth process, that can produce brain damage bonding close physical and emotional contact between parent and child during the period immediately following birth, argued by some to affect later relationship strength Developed by physician Virginia Apgar (1909–1974), the scale directs attention to five basic qualities, recalled most easily by using Apgar’s name as a guide: appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (respiratory effort). Using the Apgar scale, health care workers assign the newborn a score ranging from 0 to 2 on each of the five qualities, producing an overall score that can range from 0 to 10. The vast majority of children score 7 or above. The 10 percent of neonates who score less than 7 require help to start breathing. Newborns who score less than 4 need immediate, lifesaving intervention. Low Apgar scores (or low scores on other neonatal assessments, such as the Brazelton Neonatal Behavioral Assessment Scale, which we discuss in Chapter 4) may indicate problems or birth defects that were already present in the fetus. However, the process of birth itself may sometimes cause difficulties. Among the most profound are those relating to a temporary deprivation of oxygen. At various junctures during labor, the fetus may lack sufficient oxygen. This can happen for any of a number of reasons. For instance, the umbilical cord may get wrapped around the neck of the fetus. The cord can also be pinched during a prolonged contraction, thereby cutting off the supply of oxygen that flows through it. Lack of oxygen for a few seconds is not harmful to the fetus, but deprivation for any longer may cause serious harm. A restriction of oxygen, or anoxia, lasting a few minutes can produce cognitive deficits such as language delays and even mental retardation due to brain cell death (Stecker et al., 2013; Hynes et al., 2014; Tazopoulou et al., 2016; Fan et al., 2021). Just after birth, newborns typically are tested for a variety of diseases and genetic conditions. The American College of Medical Genetics and Genomics recommends that all newborns be screened for 34 disorders, whereas the Health Resources and Services Administration (HRSA) recommends 35 core and 26 secondary conditions, ranging from hearing difficulties and sickle-cell anemia to extremely rare conditions such as isovaleric acidemia, a disorder involving metabolism. These disorders can be detected from a tiny quantity of blood drawn from an infant’s heel (Weismiller, 2017; Health Resources and Services Administration [HRSA], 2018). The advantage of newborn screening is that it permits early treatment of problems that might otherwise go undetected for years. In some cases, devastating conditions can be prevented through early treatment of the disorder, such as the implementation of a particular kind of diet (McClain et al., 2017; Bailey & Zimmerman, 2019; Baby’s First Test, 2020). NEWBORN MEDICAL SCREENING. In addition to assessing the newborn’s health, health care workers deal with the remnants of the child’s passage through the birth canal. You’ll recall the description of the thick, greasy substance (like cottage cheese) that covers the newborn. This material, called vernix, smooths the passage through the birth canal; it is no longer needed once the child is born and is quickly cleaned away. Newborns’ bodies are sometimes covered with a fine, dark fuzz known as lanugo, which soon disappears. The newborn’s eyelids may be puffy due to an accumulation of fluids during labor, and the newborn may have blood or other fluids on parts of its body. After being cleansed, the newborn is usually returned to the parents. The significance of this initial encounter between parent and child has become a matter of considerable controversy. Some psychologists and physicians argued that bonding, the close physical and emotional contact between parent and child during the period immediately following birth, was a crucial ingredient for forming a lasting relationship between parent and child (Lorenz, 1957). Their arguments were based in part on research conducted on nonhuman species such as ducklings. This work showed that there was a critical period just curtis/Shutterstock PHYSICAL APPEARANCE AND INITIAL ENCOUNTERS. The perfect image of newborns portrayed in commercials, television programs, and movies differs dramatically from reality. email [email protected] Chapter 3 Birth and the Newborn Infant after birth when organisms showed a particular readiness to learn, or imprint, from other members of their species who happened to be present. When the concept of bonding is applied to humans, it suggests that a critical period may begin just after birth and lasts only a few hours. During this period, actual skin-to-skin contact between mother and child supposedly leads to deep, emotional bonding. The corollary to this assumption is that if circumstances prevent such contact, such as a newborn’s medical condition, the bond between mother and child will forever be lacking in some way. When developmental researchers carefully reviewed the research, however, they found little support for the existence of a critical period for bonding at birth. Although it does appear that mothers who have early physical contact with their babies are more responsive to them than those who don’t have such contact, the difference lasts only a few days. Such news is reassuring to parents whose children must receive immediate, intensive medical attention just after birth. It is also comforting to parents who adopt children and are not present at their births (Bigelow & Power, 2012; Hall et al., 2014; Schmidt et al., 2016). Although immediate mother–child bonding does not seem critical, it is important for newborns to be gently touched and massaged soon after birth. The physical stimulation they receive leads to the production of chemicals in the brain that instigate growth. Consequently, infant massage is related to weight gain, better sleep–waking patterns, better neuromotor development, and reduced rates of infant mortality (Álvarez, et al., 2017; Van Puyvelde et al., 2019; Abdulghani et al., 2020). (Also see From Research to Practice.) Although the observation of nonhuman animals highlights the importance of contact between mother and offspring following birth, research on humans suggests that immediate physical contact is less critical. From Research to Practice Does Babywearing Influence Maternal Responsiveness? Next time you are on the street or in a park, observe parents with babies and note the proportion of parents carrying their babies in a sling or other form of carrier close to their bodies (i.e., babywearing) and what proportion carry their babies in a stroller. In many non-Western societies, parents tend to adopt proximal caregiving, which is characterized by carrying their babies close to their bodies during the day and sharing beds with them at night. By contrast, parents in Western societies tend to engage in distal caregiving using strollers, cribs, playpens, and swings, thereby limiting the amount of time parents spend in close physical contact with their newborns and infants. Recently, however, a growing number of parents in Western societies are choosing to engage in babywearing, a hallmark of proximal caregiving. There is cross-cultural evidence that shows that caregivers who engage in proximal care have heightened responsiveness to babies; that is, they respond promptly to infant cues and use immediate strategies to soothe babies, such as breastfeeding. Parental responsiveness is essential for the survival of newborns because humans are completely dependent on their parents’ care for the first years of life. Moreover, prompt and contingent parental responses have a positive influence on infant development by fostering attachment formation and enhancing learning (Keller et al., 2009; Dunst & Kassow, 2008; Broesch et al., 2016). Do you think an infant’s development is affected by babywearing? New research suggests that it does. Western 95 myrrha/E+/Getty Images for more ebook/ testbank/ solution manuals requests: mothers who engage in babywearing are more responsive to their babies’ cues than are mothers who did not babywear. In a series of three studies, psychologist Emily E. Little and her colleagues examined the effects of babywearing on maternal responsiveness among U.S. college-educated mothers. Little and her colleagues found that babywearing mothers were more attentive and responsive to their infants’ cues than were mothers who did not engage in the practice. Moreover, babywearing mothers’ parenting beliefs were closer to the parenting beliefs of cultures practicing proximal care than were those of the mothers who did not babywear. Finally, mother–infant physical contact had a direct, immediate positive effect on maternal responsiveness (Little et al., 2019). The researchers argued that mother–infant physical contact through babywearing might increase maternal responsiveness in two different ways. First, physical contact heightens mothers’ perception of subtle cues that would go unnoticed otherwise, supporting maternal attentiveness. Second, physical contact strengthens the mother–infant bond, increasing maternal motivation to act promptly in response to infant cues. Shared Writing Prompt Most of the research discussed here focuses on pairs of infants and their biological mothers. Do you think that similar results apply to other caregivers, such as the responsiveness of nonbiological mothers, fathers, or grandparents? 96 PART 1 Beginnings Approaches to Childbirth: Where Medicine and Attitudes Meet LO 3.3 Describe some of the current approaches to childbirth. Oleksiy Maksymenko/Alamy Stock Photo Carrie Blackstone had her first baby under the supervision of medical doctors and found the experience impersonal and artificial. So for her second baby, she and her husband, Sami McClough, decided on an African method of birthing that she had read about. “The African way is more natural. You sit on a birthing stool, which has a hole in the middle. The baby comes through the hole, no fuss, no muss. And no doctors unless they’re needed.” Carrie and Sami found a nurse-midwife program at Manhattan’s Maternity Center that would permit her to use the stool. When the time came, Carrie and Sami were together through the whole process. With the first contractions, Sami helped her to stand up and they began rocking, “like a slow, comfortable dance,” she says. “The rocking helped me through the worst contractions. “Then I sat on the stool and when the midwife said ‘Push!’ out came my Dara’s head.” The midwife placed Dara on Carrie’s breast and examined her then and there. Parents in the Western world have developed a variety of strategies—and some strong opinions—to help them deal with something as natural as giving birth, which occurs apparently without much thought throughout the nonhuman animal world. Today parents need to make a number of decisions. Should the birth take place in a hospital or in the home? Should a physician, a nurse, or a midwife assist? Is the father’s presence desirable? Should siblings and other family members be on hand to participate in the birth? Most of these questions cannot be answered definitively, primarily because the choice of childbirth techniques often comes down to a matter of values and opinions. No single procedure will be effective for all mothers and fathers, and no conclusive research evidence has proven that one procedure is significantly more effective than another. As we’ll see, there is a wide variety of different issues and options involved, and certainly one’s culture plays a role in choices of birthing procedures. The abundance of choices is largely due to a reaction to traditional medical practices that had been common in the United States until the early 1970s. Before that time, the typical birth went something like this: A woman in labor was placed in a room with many other women, all of whom were in various stages of childbirth and some of whom were screaming in pain. Fathers and other family members were not allowed to be present. Just before delivery, the woman was rolled into a delivery room, where the birth took place. Often she was so drugged that she was not aware of the birth at all. At the time, physicians argued that such procedures were necessary to ensure the health of the newborn and the mother. However, critics charged that alternatives were available that not only would maximize the medical well-being of the participants in the birth but also would represent an emotional and psychological improvement (Curl et al., 2004; Hotelling & Humenick, 2005). Not all mothers give birth in hospitals, and not all births follow a traditional course. Among the major alternatives to traditional birthing practices are the following: ALTERNATIVE BIRTHING PROCEDURES. Some women choose to use a midwife to assist them in their pregnancy and delivery. Lamaze birthing. The Lamaze method has achieved widespread popularity in the United States. Based on the writings of Dr. Fernand Lamaze (1891–1957), the method makes use of breathing techniques and for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant relaxation training (Lamaze, 1970). Typically, mothers-to-be participate in a series of weekly training sessions in which they learn exercises that help them relax various parts of the body on command. A “coach,” most typically the father or the mother’s partner, is trained along with the future mother. The training allows women to cope with painful contractions by concentrating on their breathing and producing a relaxation response, rather than by tensing up, which can make the pain more acute. Women learn to focus on a relaxing stimulus, such as a tranquil scene in a picture. The goal is to learn how to deal positively with pain and to relax at the onset of a contraction (Lothian, 2005; Haseli et al., 2019). Does the procedure work? Most mothers, as well as fathers, report that a Lamaze birth is positive experience. They enjoy the sense of mastery that they gain over the process of labor, a feeling of being able to exert some control over what can be a formidable experience. Given that, we can’t be sure that parents who choose the Lamaze method aren’t already more highly motivated about the experience of childbirth than parents who do not choose the technique. It is therefore possible that the accolades they express after Lamaze births are due to their initial enthusiasm and not to the Lamaze procedures themselves (Larsen et al., 2001; Zwelling, 2006; Lönnberg et al., 2021). Participation in Lamaze procedures—as well as other natural childbirth techniques in which the emphasis is on educating the parents about the process of birth and minimizing the use of drugs—is relatively rare among members of lower-income groups, including many members of ethnic minorities. Parents in these groups may not have the transportation, time, or financial resources to attend childbirth preparation classes. The result is that women in lower-income groups tend to be less prepared for the events of labor and consequently may suffer more pain during childbirth (Lu et al., 2003). Bradley method. The Bradley method, which is sometimes known as “partner-coached childbirth,” is based on the principle that childbirth should be as natural as possible and involve no medication or medical interventions. Women are taught to “tune into” their bodies to deal with the pain of childbirth. To prepare for childbirth, mothers-to-be are taught muscle relaxation techniques, similar to Lamaze procedures, and good nutrition and exercise during pregnancy are seen as important to prepare for delivery. Parents are urged to take responsibility for childbirth, and the use of physicians is viewed as unnecessary and sometimes even dangerous. As you might expect, the discouragement of traditional medical interventions is quite controversial, and there is little scientific research to show the effectiveness of the Bradley method (Gurevich, 2021; Healthline, 2021). Mindfulness-based birthing. Mindfulness-based childbirth is based on the idea that mindfulness, the awareness that comes from purposely paying attention in the moment to what is occurring, is central to the experience of childbirth. The approach particularly focuses on learning how to engage the mother’s mind with the experience of pain and using her inner resources to deal with the birthing process. Expectant mothers, as well as their partners, learn meditation practices such as yoga. There is a body of scientific research that supports the method, showing that mindfulness training has mental health benefits for mothers and reducing their anxiety and depression following birth (Bardacke, 2012; Duncan et al., 2017; El Morr et al., 2020). Hypnobirthing. Hypnobirthing is an increasingly popular technique. It involves a form of self-hypnosis during delivery that creates a sense of peace and calm, thereby reducing pain. The basic concept is to produce a state of focused concentration in which a mother relaxes her body while focusing inward. Increasing research evidence shows the technique can be effective in reducing pain (Olson, 2006; White, 2007; Alexander et al., 2009; Bhagat & Menon, 2020). Water birthing. Still relatively uncommon in the United States, water birthing is a practice in which a woman enters a pool of warm water to give birth. The theory is that the warmth and buoyancy of the water is soothing, easing the length and pain of labor 97 Rafael Ben-Ari/Alamy Stock Photo 98 PART 1 Beginnings and childbirth, and the entry into the world is soothed for the infant, who moves from the watery environment of the womb to the birthing pool. Although there is some evidence that water birthing reduces pain and the length of labor, there is a risk of infection from unsterile water (Thöni et al., 2010; Jones et al., 2012; Hodgson et al., 2020). CHILDBIRTH ATTENDANTS: WHO DELIVERS? Traditionally, obstetricians, physicians who specialize in delivering babies, have been the childbirth attendants of choice. In the past few decades, more mothers have chosen to use a midwife, a childbirth attendant who stays with the mother throughout labor and delivery. Midwives—most often nurses specializing in childbirth—are used primarily for pregnancies in which no complications are expected. The With water birthing, the woman enters a pool of warm water to give birth. use of midwives has increased steadily in the United States— there are now 7,000 of them—and they are employed in 10 percent of births. Midwives help deliver some 80 percent of babies in other parts of the world, often at home. Home birth is common in countries at all levels of economic development. For instance, a third of all births in the Netherlands occur at home (Klein, 2012; Sandall, 2014; Kvernflaten, 2019). From a Health Care Provider’s Perspective Although 99 percent of U.S. births are attended by professional medical workers or birthing attendants, this is the case in only about 66 percent of births worldwide. What do you think are some reasons for this, and what are the implications of this statistic? One of the newer trends in childbirth assistance is also one of the oldest: the use of a doula (pronounced doo-lah). A doula is trained to provide emotional, psychological, and educational support during birth. A doula does not replace an obstetrician or a midwife and does not do medical examinations. Instead, doulas, who are often well-versed in birthing alternatives, provide the mother with support and make sure the parents are aware of alternatives and possibilities regarding the birth process. Although the use of doulas is new in the United States, they represent a return to an older tradition that has existed for centuries in other cultures. They may not be called doulas, but supportive, experienced older women have helped mothers as they give birth in non-Western cultures for centuries. A growing body of research indicates that the presence of a doula is beneficial to the birth process, speeding deliveries and reducing reliance on drugs. Yet concerns remain about their use. Unlike certified midwives, who are nurses and receive an additional year or two of training, doulas do not need to be extensively certified or have any particular level of education (Humphries & Korfmacher, 2012; Simkin, 2014; Darwin et al., 2017; Sperlich et al., 2019). PAIN AND CHILDBIRTH. Any woman who has delivered a baby will agree that childbirth is painful. But exactly how painful is it? Such a question is largely unanswerable. One reason is that pain is a subjective, psychological phenomenon, one that cannot be easily measured. No one is able to answer the question of whether their pain is “greater” or “worse” than someone else’s pain, although some studies have tried to quantify it. For instance, in one survey, women were asked to rate the pain they experienced during labor on a 1 to 5 scale, with 5 being the most painful. Nearly half (44 percent) said “5,” and an additional one-quarter said “4.” (Yarrow, 1992; Striebich & Ayerle, 2019). Because pain is usually a sign that something is wrong in one’s body, we have learned to react to pain with fear and concern. Yet during childbirth, pain is actually a signal that the body is working appropriately and that the contractions that are meant to propel the baby through the birth canal are doing their job. Consequently, the experience of pain for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 99 Developmental Diversity and Your Life How the Pain of Childbirth Differs Across Cultures Every woman’s delivery depends on such factors as how much preparation and support she has before and during delivery, the specific nature of the delivery, and her culture’s view of pregnancy and delivery. It also turns out that the experience of pain differs across cultures. For example, women in India report that labor is less painful than do women in the United States. Even within Western cultures, pain is viewed differently. For example, in Belgium, women view pain as something to be avoided through the use of medication. In contrast, women living in the Netherlands see labor pain as normal and helpful to the birth process, and thus something to be embraced (Christiaens et al., 2010). It is unlikely that the physiological reactions resulting in the perception of pain to labor differ across different cultures. Instead, it is the way the pain is perceived that makes the difference. Labor and delivery clearly depend, at least in part, on a woman’s state of mind (de Williams et al., 2013; Karlsdottiret al., 2014; Steel et al., 2014; Wilsona & Simpson, 2016). during labor is difficult for women in labor to interpret, thereby potentially increasing their anxiety and making the contractions seem even more painful (also see Developmental Diversity and Your Life). Among the greatest advances of modern medicine is the ongoing discovery of drugs that reduce pain. However, the use of medication during childbirth is a practice that holds both benefits and pitfalls. Around 70 percent who receive anesthesia during labor do so in the form of epidural anesthesia, which produces numbness from the waist down. Traditional epidurals produce an inability to walk and in some cases prevent women from helping to push the baby out during delivery. However, a newer form of epidural, known as a walking epidural or dual spinal–epidural, uses smaller needles and a system for administering continuous doses of anesthetic. It permits women to move about more freely during labor and has fewer side effects than traditional epidural anesthesia (Butwick et al., 2018; Onuoha, 2017; Arnal, 2020). It is clear that drugs hold the promise of greatly reducing, and even eliminating, pain associated with labor, which can be extreme and exhausting. But pain reduction comes at a cost: Drugs administered during labor reach not just the mother but the fetus as well. The stronger the drug, the greater its effects on the fetus and neonate. Because of the small size of the fetus relative to the mother, drug doses that might have only a minimal effect on the mother can have a magnified effect on the fetus. Anesthetics may temporarily depress the flow of oxygen to the fetus and slow labor. In addition, newborns whose mothers have been anesthetized are less physiologically responsive, show poorer motor control during the first days after birth, cry more, and may have more difficulty initiating breastfeeding (Torvaldsen et al., 2006; Black et al., 2019). Still, most research suggests that drugs, as they are currently employed during labor, produce only minimal risks to the fetus and neonate. Guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) suggest that a woman’s request for pain relief at any stage of labor should be honored and that the proper use of minimal amounts of drugs for pain relief is reasonable and has no significant effect on a child’s later well-being (American College of Obstetricians and Gynecologists [ACOG], 2002; Alberts et al., 2007; Costa-Martins et al., 2014). USE OF ANESTHESIA AND PAIN-REDUCING DRUGS. When New Jersey mother Diane Mensch was sent home from the hospital just a day after the birth of her third child, she still felt exhausted. But her insurance company insisted that 24 hours was sufficient time to recover, and it refused to pay for more. Three days later, her newborn was back in the hospital, suffering from jaundice. Mensch is convinced the problem would have been discovered and treated sooner had she and her newborn been allowed to remain in the hospital longer (Begley, 2020). POSTDELIVERY HOSPITAL STAY: DELIVER, THEN DEPART? Mensch’s experience is not unusual, at least for mothers in the United States. In the 1970s, the average hospital stay for a normal birth was around 4 days. Now, it is 2 days. These changes were prompted in large part by medical insurance companies, who advocated hospital stays of only 24 hours following birth to reduce costs. In other countries, mothers routinely stay longer after delivery. For example, mothers in the Ukraine and Moldova stay an average of 6 days, and 5 days is routine in Hungary and Romania. By contrast, mothers in Egypt average just half a day (Campbell et al., 2016; Kruse et al., 2021; see Figure 3-2). Medical care providers believe that there are definite risks involved, both for mothers and for their newborns, for too fast a departure from hospitals. For Mothers who spend more time in the hospital following the birth of a child do better than those who are discharged after a shorter period. instance, mothers may begin to bleed if they tear tissue injured during childbirth. It is also riskier for newborns to be discharged prematurely from the sophisticated medical care that hospitals can provide. Furthermore, mothers are better rested and more satisfied with their medical care when they stay longer (Campbell et al., 2016). In accordance with these views, the U.S. Congress has passed legislation mandating a minimum insurance coverage of 48 hours for childbirth. Furthermore, the American Academy of Pediatrics has issued comprehensive guidelines detailing how long women (and their infants) should stay in the hospital based on various health criteria relating to the infant and mother (Benitz, 2015; National Conference of State Legislatures, 2020). Figure 3-2 Average Stay in Hospital After Childbirth The length of stay after giving birth varies considerably by country. (Source: Campbell et al., 2016.) 7 6 5 4 3 2 1 0 U k Sl rai o n H vak e un i Cz ec g a h Cy ary Re p p ru Bu ub s lg lic Lu a xe Fr ria m an bo ce Be u r Sl lgiu g Sa ov m o To Po eni m e A lan a & u d Pr str i M nci ia a p Li ldi e th ve ua s Sw n itz Lat ia er via la nd N Ita or ly F wa G inla y er n m d an In y d Is ia ra A Ch el us il tr e G alia ab o Re D Ma n en l pu t m bl N a a ic am rk of ib Ko ia r S ea Sw pa in Le ede so n U ni I th te re o d lan St d N at et e he Ha s r la iti N ew N nd i Z ge s H eal ria on a d n U B C ur d ni an a as te g na d la d Ki de a ng sh U do ga m Tu nda r M ke ex y Eg ico yp t AMELIE BENOIST/BSIP SA/Alamy Stock Photo 100 PART 1 Beginnings for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 101 Module 3.1 Review LO 3.1 Describe the normal process of labor. In the first stage of labor, contractions increase in frequency, duration, and intensity until the baby’s head is able to pass through the cervix. In the second stage, the baby moves through the cervix and birth canal and leaves the mother’s body. In the third stage, the umbilical cord and placenta emerge. LO 3.2 Explain the events that occur in the first few hours of a newborn’s life. Immediately after birth, birthing attendants usually examine the neonate using a measurement system such as the Apgar scale. Newborns are also typically tested for a variety of diseases and genetic conditions. The newborn is usually returned to its parents shortly after birth so that they may hold and bond with the baby. LO 3.3 Describe some of the current approaches to childbirth. Many birthing options are available to parents today. They may use a midwife or doula in addition to or instead of an obstetrician, and they may weigh the advantages and disadvantages of anesthetic drugs during birth. Some women choose alternatives to traditional hospital birthing, including the Lamaze method, the Bradley method, hypnobirthing, and water birthing. Journal Prompt Applying Lifespan Development: Why might cultural differences exist in expectations and interpretations of labor? Birth Complications When Ivy Brown’s son was stillborn, a nurse told her that sad as it was, nearly 1 percent of births in her city, Washington, DC, ended in death. That statistic spurred Brown to become a grief counselor, specializing in infant mortality. She formed a committee of physicians and city officials to study the capital’s high infant mortality rate and find solutions to lower it. “If I can spare one mother this terrible grief, my loss will not be in vain,” Brown says. The infant mortality rate in Washington, DC, capital of the richest country in the world, is 7.1 deaths per 1,000 births, exceeding the rate of places such as Hungary, Cuba, Kuwait, and Hong Kong. Overall, 54 countries have better birth rates than the United States, which has 5.7 deaths for every 1,000 live births (Centers for Disease Control and Prevention [CDC], 2021; see Figure 3-3). Why is infant survival less likely in the United States than in quite a few less developed countries? To answer this question, we need to consider the nature of the problems that can occur during labor and delivery. Preterm Infants: Too Soon, Too Small LO 3.4 Describe some of the causes of, effects of, and treatments for preterm births. Around 1 out of 10 infants are born earlier than normal. Preterm infants, or premature infants, are born prior to 38 weeks after conception. Because they have not had time to develop fully as fetuses, preterm infants are at high risk for illness and death. The extent of danger faced by preterm babies largely depends on the child’s weight at birth, which has great significance as an indicator of the extent of the baby’s development. Although the average newborn weighs around 3,400 grams (about 7 1/2 pounds), low-birthweight infants weigh less than 2,500 grams (around 5 1/2 pounds). Only 7 percent of all newborns in the United States fall into the low-birthweight category, but they account for the majority of newborn deaths (DeVader et al., 2007; Martin et al., 2018). Although most low-birthweight infants are preterm, some are small-for-gestational-age babies. Small-for-gestational-age infants are infants who, because of delayed fetal growth, weigh 90 percent (or less) of the average weight of infants of the same gestational age. Smallfor-gestational-age infants are sometimes also preterm, but may not be. The syndrome may be caused by inadequate nutrition during pregnancy (Salihu et al., 2013; He et al., 2021). If the degree of prematurity is not too great and weight at birth is not extremely low, the threat to the child’s well-being is relatively minor. In such cases, the main treatment may be to keep the baby in the hospital to gain weight. Additional weight is critical preterm infants infants who are born prior to 38 weeks after conception (also known as premature infants) low-birthweight infants infants who weigh less than 2,500 grams (around 5 1/2 pounds) at birth small-for-gestational-age infants infants who, because of delayed fetal growth, weigh 90 percent (or less) of the average weight of infants of the same gestational age 102 PART 1 Beginnings because fat layers help prevent chilling in neonates, who are not particularly efficient at regulating body temperature. Infant mortality rates in selected countries. Although the United Research also shows that preterm infants who receive States has greatly reduced its infant mortality rate in the past more responsive, stimulating, and organized care are apt to 25 years, it still ranks behind numerous other industrialized countries. What are some of the reasons for this? show more positive outcomes than those children whose care (Source: Central Intelligence Agency, 2017.) is not as good. Some of these interventions are quite simple. For example, “kangaroo care,” in which infants are held skin-to-skin Japan against their parents’ chests, appears to be effective in helpSingapore ing preterm infants develop. Massaging preterm infants sevNorway eral times a day triggers the release of hormones that promote Finland weight gain, muscle development, and the ability to cope with Sweden stress (Athanasopoulou & Fox, 2014; Nobre et al., 2017; WHO Czech Republic Hong Kong Immediate KMC Study Group, 2021). France Newborns who are born more prematurely and who have Italy birthweights significantly below average face a tougher road. Spain For them, simply staying alive is a major task. For instance, Belgium low-birthweight infants are highly vulnerable to infection, and Germany because their lungs have not had sufficient time to develop Israel completely, they have problems taking in enough oxygen. As a Ireland consequence, they may experience respiratory distress syndrome Denmark (RDS), with potentially fatal consequences. Australia United Kingdom To deal with RDS, low-birthweight infants are often placed Portugal in incubators, enclosures in which temperature and oxygen Poland content are controlled. The exact amount of oxygen is carefully New Zealand monitored. Too low a concentration of oxygen will not provide Cuba relief, and too high a concentration can damage the delicate retiCanada nas of the eyes, leading to permanent blindness. Greece The immature development of preterm neonates makes them Hungary unusually sensitive to stimuli in their environment. They can easSlovakia ily be overwhelmed by the sights, sounds, and sensations they United States Russia experience, and their breathing may be interrupted or their heart Kuwait rates may slow. They are often unable to move smoothly; their Costa Rica arm and leg movements are uncoordinated, causing them to jerk Romania about and appear startled. Such behavior is quite disconcerting to 10 0 5 parents (Miles et al., 2006; Valeri et al., 2014). Number of Deaths per Thousand Despite the difficulties they experience at birth, the majority of preterm infants eventually develop normally. However, the tempo of development often proceeds more slowly for preterm children compared to children born at full term, and more subtle problems sometimes emerge later. For example, by the end of their first year, only 10 percent of prematurely born infants display significant problems, and only 5 percent are seriously disabled. By age 6, however, approximately 38 percent have mild problems that call for special educational interventions. For instance, some preterm children show learning disabilities, behavior disorders, or lower-than-average IQ scores. They also may be at greater risk for mental illness. Others have difficulties with physical coordination. Still, around 60 percent of preterm infants are free of even minor problems (El Ayoubi et al., 2016; McLeod et al., 2020; Soleimani et al., 2020). Figure 3-3 International Infant Mortality very-low-birthweight infants infants who weigh less than 1,500 grams (around 3 pounds, 4 ounces) or, regardless of weight, have been in the womb less than 30 weeks VERY-LOW-BIRTHWEIGHT INFANTS: THE SMALLEST OF THE SMALL. The story is less positive for the most extreme cases of prematurity—very-low-birthweight infants. Very-low-birthweight infants weigh less than 1,500 grams (around 3 pounds, 4 ounces) or, regardless of weight, have been in the womb less than 30 weeks. Very-low-birthweight infants not only are tiny—some fitting easily in the palm of the hand at birth—but they also hardly seem to belong to the same species as full-term newborns. Their eyes may be fused shut and their earlobes may look like flaps of skin on the sides of their heads. Their skin is a darkened red color, whatever their race. email [email protected] Chapter 3 Birth and the Newborn Infant 103 Very-low-birthweight babies are in grave danger from the moment they are born because of the immaturity of their organ systems. Before the mid-1980s, these babies would not have survived outside their mothers’ wombs. However, medical advances have led to a higher chance of survival, pushing the age of viability, the point at which an infant can survive prematurely, to about 22 weeks—some 4 months earlier than the term of a normal delivery. Of course, the longer the period of development beyond conception, the higher are a newborn’s chances of survival. A baby born earlier than 25 weeks has less than a 50–50 chance of survival (see Figure 3-4; Seaton et al., 2012; He et al., 2019). The physical and cognitive problems experienced by low-birthweight and preterm babies are even more pronounced in very-low-birthweight infants, with astonishing financial consequences. Each day in an incubator in a neonatal intensive care unit can cost $10,000, and some medical bills may run in the millions of dollars (Sinconis, 2018). Even if a very-low-birthweight preterm infant survives, the medical costs can continue to mount. For instance, one estimate suggests that the average monthly cost of medical care for such infants during the first 3 years of life may be between 3 and 50 times higher than the medical costs for a full-term child. Such astronomical costs have raised ethical debates about the expenditure of substantial financial and human resources in cases in which a positive outcome Preterm infants stand a much greater chance of may be unlikely (Stephens et al., 2016; Grosse et al., 2017; Cheah, 2019). As medical capabilities progress and developmental researchers come up survival today than they did even a decade ago. with new strategies for dealing with preterm infants and improving their lives, the age of viability is likely to be pushed even earlier. Emerging evidence suggests that high-quality care can provide protection from some of the risks associated with prematurity, and that in fact by the time they reach adulthood, premature babies may be little different from other adults. Still, the costs of caring for preterm infants are enormous: The U.S. government estimates that caring for premature infants costs $26 billion a year (Saul, 2009; Cheah, 2019; Beam et al., 2020). Figure 3-4 Survival and Gestational Age The chances of a fetus surviving greatly improve from 22 weeks to 25 weeks. Figures shown are infant mortality rates per 1,000 live births, and illustrate improvements in survival from 1993 through 2015. (Source: Stoll et al., 2015.) Percentage of Live Births that Survived to Be Discharged from the Hospital 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 22 weeks 23 weeks 24 weeks 25 weeks Gestational Age 1993–1997 1998–2002 2003–2007 2008–2012 2013–2015 Chuck Nacke/Alamy Stock Photo for more ebook/ testbank/ solution manuals requests: 104 PART 1 Beginnings WHAT CAUSES PRETERM AND LOW-BIRTHWEIGHT DELIVERIES? About half of preterm and low-birthweight births are unexplained, but several known causes account for the remainder. In some cases, premature labor results from difficulties relating to the mother’s reproductive system. For instance, mothers carrying twins have unusual stress placed on them, which can lead to early labor. In fact, most multiple births are preterm to some degree (Luke & Brown, 2008; Saul, 2009; Habersaat et al., 2014). In other cases, preterm and low-birthweight babies are a result of the immaturity of the mother’s reproductive system. Young mothers—younger than age 15—are more prone to deliver prematurely than mothers in their 20s and 30s. Furthermore, women older than 40 tend to have higher rates of premature deliveries (March of Dimes, 2021). In addition, a woman who becomes pregnant within 6 months of a previous delivery is more likely to deliver a preterm or low-birthweight infant than a woman whose reproductive system has had a chance to recover from a prior delivery. The father’s age matters, too: Pregnant women with older male partners are more likely to have preterm deliveries (Blumenshine et al., 2011; Teoli et al., 2015). Finally, factors that affect the general health of the mother, such as nutrition, level of medical care, amount of stress in the environment, and economic support, all are related to prematurity and low birthweight. Rates of preterm births differ between racial groups, not because of race per se but because members of racial minorities have disproportionately lower incomes and face issues of racism and inequality. For instance, the percentage of low-birthweight infants born to Black American mothers is double that for white American mothers. (A summary of the factors associated with increased risk of low birthweight is shown in Table 3-2; Butler et al., 2012; Teoli et al., 2015; Wang & Jin, 2020.) Table 3-2 Birthweight Risk Factors for Low-Birthweight Preterm Infants Women who have delivered preterm before or who have experienced preterm labor Being pregnant with twins, triplets, or higher-order multiples The use of assisted reproductive technologies Certain medical conditions, including: Urinary tract infections Sexually transmitted infections Certain vaginal infections High blood pressure Bleeding from the vagina Certain developmental abnormalities in the fetus Being underweight or obese before pregnancy Short time period between pregnancies (less than 6 months between a birth and the beginning of the next pregnancy) Placenta previa, a condition in which the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix Being at risk for rupture of the uterus Diabetes Blood-clotting problems Other Factors That May Increase Risk for Preterm Labor and Premature Birth Include: Race and ethnicity: preterm labor and birth occur more often among certain racial and ethnic groups due to racism, segregation, and inequality Age of the mother: younger than 15 and older than 40 Certain lifestyle and environmental factors, including: Late or no health care during pregnancy Smoking Drinking alcohol Using illegal drugs Domestic violence, including physical, sexual, or emotional abuse Lack of social support Stress Long working hours with long periods of standing Exposure to certain environmental pollutants Source: U.S. Department of Health and Human Services, National Institutes of Health, Eunice Kennedy Shriver Institute of Child Health and Human Development, 2017; Beck et al., 2020. for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 105 Postmature Babies: Later, Larger LO 3.5 Identify the risks that postmature babies face. One might imagine that a baby who spends extra time in the womb might have some advantages, given the opportunity to continue growth undisturbed by the outside world. Yet postmature infants—those unborn 2 weeks after the mother’s due date—face several risks. For example, the blood supply from the placenta may become insufficient to nourish the still-growing fetus adequately. Consequently, the blood supply to the brain may be decreased, leading to the potential of brain damage. Similarly, labor becomes riskier (for both the child and the mother) as a fetus—who may be equivalent in size to a 1-month-old infant—has to make its way through the birth canal (Fok et al., 2006). Difficulties involving postmature infants are more easily prevented than those involving preterm babies because medical practitioners can induce labor artificially if the pregnancy continues too long. Not only can certain drugs bring on labor, but physicians also have the option of performing cesarean deliveries, a form of delivery we consider next. postmature infants infants unborn 2 weeks after the mother’s due date Cesarean Delivery: Intervening in the Process of Birth LO 3.6 Describe the process of cesarean delivery and the reasons for its increase in use. Elena became one of the more than one million mothers in the United States who have a cesarean delivery each year. In a cesarean delivery (sometimes known as a c-section), the cesarean delivery baby is surgically removed from the uterus rather than traveling through the birth canal. a birth in which the baby is surgiCesarean deliveries occur most frequently when the fetus shows distress of some cally removed from the uterus, sort. For instance, if the fetus appears to be in danger, as indicated by a sudden rise in its rather than traveling through the heart rate, or if blood is seen coming from the mother’s vagina during labor, a cesarean birth canal may be performed. In addition, mothers older than age 40 are more likely to have cesarean deliveries than younger mothers. Overall, cesarean deliveries in the United States fetal monitor now make up 32 percent of all deliveries (Romero et al., 2012; Martin et al., 2021). a device that measures the baby’s Cesarean deliveries are also used in some cases of breech position, in which the baby heartbeat during labor is positioned feet first in the birth canal. Breech position births, which occur in about 1 out of 25 births, place the baby at risk because the umbilical cord is more likely to be compressed, depriving the baby of oxygen. Cesarean deliveries are also more likely in transverse position births, in which the baby lies crosswise in the uterus, or when the baby’s head is so large it has trouble moving through the birth canal. The routine use of a fetal monitor, a device that measures the baby’s heartbeat during labor, has contributed to a soaring rate of cesarean deliveries. Nearly a third of all children in the United States are born in this way, up some 500 percent from the early 1970s, when the rate stood at 5 percent (Hamilton et al., 2011; Paterno et al., 2016). Are cesareans an effective medical intervention? Other countries have substantially lower rates of cesarean deliv- The use of fetal monitoring has contributed to a sharp increase of cesarean eries (see Figure 3-5), and there is no association between deliveries despite evidence showing few benefits from the procedure. Tyler Olson/Shutterstock As Elena entered her 18th hour of labor, the obstetrician who was monitoring her progress began to look concerned. She told Elena and her husband, Pablo, that the fetal monitor revealed that the fetus’s heart rate had begun to repeatedly fall after each contraction. After trying some simple remedies, such as repositioning Elena on her side, the obstetrician came to the conclusion that the fetus was in distress. She told them that the baby should be delivered immediately, and to accomplish that, she would have to carry out a cesarean delivery. 106 PART 1 Beginnings Figure 3-5 Cesarean Deliveries per 1,000 Live Births The rate at which cesarean deliveries are performed varies substantially from one country to another. Why do you think the United States has a high rate? (Source: Organisation for Economic Co-operation and Development (OECD), 2020.) 500 400 300 200 100 d a Sw nd ed e Es n to ni Li th a ua n D en ia m ar Fr k an B ce el gi Sl um o C ven o C ze sta ia ch R ic R ep a ub lic La tv ia N ew Sp ai Ze n al an U d ni C te an d K ada in gd om Sl ov Au ak st r R ep ia ub G lic e Lu rm xe an y m Sw bo itz urg U ni erl an te d d St at es Ire la nd Ita H l un y ga ry Po la nd K or e Tu a rk ey an nl el Ic Fi ay w s N or nd ra Is et he rla el 0 N Cesarean Deliveries per 1,000 Live Births 600 successful birth consequences and the rate of cesarean deliveries. In addition, cesarean deliveries carry dangers. Cesarean delivery represents major surgery, and the mother’s recovery can be relatively lengthy, particularly when compared to a normal delivery. In addition, the risk of maternal infection is higher with cesarean deliveries (Hutcheon et al., 2013; Ryding et al., 2015; Rodriguez, 2020). Finally, a cesarean delivery presents some risks for the baby. Because cesarean babies are spared the stresses of passing through the birth canal, their relatively easy passage into the world may deter the normal release of certain stress-related hormones, such as catecholamines, into the newborn’s bloodstream. These hormones help prepare the neonate to deal with the stress of the world outside the womb, and their absence may be detrimental to the newborn child. In fact, research indicates that babies born by cesarean delivery who have not experienced labor are more likely to experience breathing problems upon birth than those who experience at least some labor prior to being born via a cesarean delivery. Mothers who deliver by cesarean are often less satisfied with the birth experience, but their dissatisfaction does not influence the quality of mother–child interactions (MacDorman et al., 2008; Xie et al., 2015; Kjerulff & Brubaker, 2018). Because the increase in cesarean deliveries is, as we have said, connected to the use of fetal monitors, medical authorities now currently recommend that fetal monitors not be used routinely. There is evidence that outcomes are no better for newborns who have been monitored than for those who have not been monitored. In addition, monitors tend to indicate fetal distress when there is none—false alarms—with disquieting regularity. Monitors do, however, play a critical role in high-risk pregnancies and in cases of preterm and postmature babies (Freeman, 2007; Sepehri & Guliani, 2017). Studies examining what appear, in retrospect, to be unnecessary cesareans have found racial and socioeconomic differences. Specifically, Black mothers are more likely to have a potentially unnecessary cesarean delivery than white mothers are. In addition, Medicaid patients—who tend to be relatively poor—are more likely to have unnecessary cesarean deliveries than non-Medicaid patients (Miani et al., 2020). for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 107 Stillbirth and Infant Mortality: The Tragedy of Premature Death LO 3.7 Describe rates of infant mortality and what factors affect these statistics. The joy that accompanies the birth of a child is completely reversed when a newborn dies. The relative rarity of their occurrence makes infant deaths even harder for parents to bear. Sometimes a child does not even live beyond its passage through the birth canal. Stillbirth, the delivery of a child who is not alive, occurs in around 1 delivery out of 160 in the United States. Sometimes the death is detected before labor begins. In this case, labor is typically induced, or physicians may carry out a cesarean delivery to remove the body from the mother as soon as possible. In other cases of stillbirth, the baby dies during its travels through the birth canal. The overall rate of infant mortality in the United States (defined as death within the first year of life) is 5.7 deaths per 1,000 live births. Infant mortality generally has been declining since the 1960s (Loggins & Andrade, 2014; Prince et al., 2016; Central Intelligence Agency, 2021). Despite the declines, the rate of infant mortality in the United States is high for a highly developed, wealthy country. Many other developed countries have lower rates of infant mortality than the United States, in part because of higher rates of premature births and lower access to high-quality pre- and postnatal care in the United States. Whether the death is a stillbirth or occurs after the child is born, the loss of a baby is tragic, and the impact on parents is enormous. The loss and grief parents feel, and their passage through it, is similar to that experienced when an older loved one dies. The juxtaposition of the first dawning of life and an unnaturally early death may make the death particularly difficult to accept and handle. Depression is common, and it is often intensified owing to a lack of support. Some parents even experience post-traumatic stress disorder (Turton et al., 2009; Davoudian et al., 2021). There are also significant differences in infant mortality related to race, socioeconomic status, and culture in infant mortality, as we discuss in Developmental Diversity and Your Life. stillbirth the delivery of a child who is not alive, occurring in 1 delivery in 160 in the United States infant mortality death within the first year of life Developmental Diversity and Your Life Overcoming Racial and Cultural Differences in Infant Mortality Even though there has been a general decline in the infant mortality rate in the United States over the past several decades, Black babies are more than twice as likely to die before age 1 than white babies. This difference is largely the result of socioeconomic factors: Black women are significantly more likely to be living in poverty than white women and to receive less prenatal care. As a result, their babies are more likely to be of low birthweight—the factor most closely linked to infant mortality—than infants of mothers of other racial groups (see Figure 3-6; Byrd et al., 2007; Rice et al., 2017). But it is not just members of particular racial groups in the United States who suffer from poor mortality rates. As mentioned previously, the rate of infant mortality in the United States is higher than the rate in many other countries. For example, the mortality rate in the United States is almost double that of Japan. Why does the United States fare so poorly in terms of newborn survival? One answer is that the United States has a higher rate of low-birthweight and preterm deliveries than many other countries. When U.S. infants are compared with infants of the same weight who are born in other countries, the differences in mortality rates disappear (Davis & Hofferth, 2012; Travers et al., 2020). Another reason for the higher U.S. mortality rate relates to economic inequality. The United States has a higher proportion of people living in poverty than many other countries. Because people in lower economic categories are less likely to have adequate medical care and tend to be less healthy, the relatively high proportion of economically deprived individuals in the United States impacts the overall mortality rate (MacDorman et al., 2005; Close et al., 2013). Many countries do a significantly better job than the United States in providing prenatal care to mothers-to-be. For instance, low-cost and even free care, both before and after delivery, is often available in other countries. Furthermore, paid maternity leave is frequently provided to pregnant women, lasting in some cases as long as 51 weeks (see Table 3-3, Figure 3-7). (Continued ) 108 PART 1 Beginnings Figure 3-6 Race and Infant Mortality Although infant mortality is dropping for all children in the United States, the death rate is still more than twice as high for Black non-Hispanic infants than for white non-Hispanics. These figures show the number of deaths in the first year of life for every 1,000 live births. (Source: Federal Interagency Forum on Child and Family Statistics, 2020.) Infant Deaths per 1,000 Live Births 12 10.5 10 9.4 8.1 8 6 4 4.6 4.9 White Hispanic 3.6 2 0 Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander In the United States, the U.S. Family and Medical Leave Act (FMLA) requires most employers to give new parents up to 12 weeks of unpaid leave following the birth (or adoption or foster care placement) of a child. However, because it is unpaid leave, the lack of pay is an enormous barrier for low-income workers, who rarely are able to take advantage of the opportunity to stay home with their child. The opportunity to take an extended maternity leave can be important: Mothers who spend more time on maternity leave may have better mental health and higher-quality interactions with their infants (Rowe-Finkbeiner et al., 2016; Mandal, 2018; Bütikofer et al., 2021). Better health care is only part of the story. In certain European countries, in addition to a comprehensive package of services involving general practitioner, obstetrician, and midwife, pregnant women receive many privileges, such as transportation benefits for visits to health care providers. In Norway, pregnant women may be given living expenses for up to 10 days so that they can be close to a hospital when it is time to give birth. And when their babies are born, new mothers receive the assistance of trained home helpers for just a small payment. In some countries, even fathers receive benefits: For example, in Sweden, fathers receive paid leave for at least 90 days (UNICEF, 2019; Peltier, 2020). In the United States, the story is different. About 1 out of every 6 pregnant women has insufficient prenatal care. Some 20 percent of white women and close to 40 percent of Black women receive no prenatal care early in their pregnancies. Black Five percent of white mothers and 11 percent of Black mothers do not see a health care provider until the last 3 months of pregnancy; some never see a health care provider at all (Cogan et al., 2012; Osterman & Martin, 2018). Ultimately, the lack of prenatal services results in a higher mortality rate. Yet this situation can be changed if greater support is provided. A start would be to ensure that all economically disadvantaged pregnant women have access to free or inexpensive high-quality medical care from the beginning of pregnancy. Furthermore, barriers that prevent poor women from receiving such care should be reduced. For instance, programs can be developed that help pay for transportation to a health facility or for the care of older children while the mother is making a health care visit. The cost of these programs is likely to be offset by the savings they make possible: Healthy babies cost less than infants who have chronic problems resulting from poor nutrition and prenatal care (Barber & Gertler, 2009; Hanson, 2012; Novoa, 2020). Figure 3-7 Government-Mandated Paid Leave for New Parents Around the Globe (Source: Livingston & Thomas, 2019.) Estonia Bulgaria Hungary Japan Austria Slovakia Norway Slovenia Germany Finland Sweden Luxembourg Poland Korea Portugal Chile Denmark Canada Italy France Greece Spain Costa Rica Netherlands Israel Mexico United Kingdom Turkey Australia Switzerland Ireland United States 0 20 40 60 Weeks of Paid Leave 80 100 for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant Table 3-3 Childbirth-Related Leave Policies in the United States and Selected Peer Nations Country Length of Leave Provided Payment Rate United States 12 weeks Unpaid Canada 54 weeks Varies; around 55 percent Denmark 32 weeks 100 percent Finland 26 weeks 70 percent of prior earnings Norway 36–46 weeks 100 percent Sweden 60 weeks 12 months at 80 percent of prior earnings, 3 months flat rate, 3 months unpaid France 156 weeks Flat rate Japan 1 year 60 percent of prior earnings United Kingdom 18 weeks Unpaid (Source: Adapted from Addati et al., 2014.) From an Educator’s Perspective Why do you think the United States lacks educational and health care policies that could reduce infant mortality rates overall and among poorer people? What arguments would you make to change this situation? Postpartum Depression: Moving from the Heights of Joy to the Depths of Despair LO 3.8 Describe the causes and effects of postpartum depression. Renata was overjoyed when she found out that she was pregnant and had spent the months of her pregnancy happily preparing for her baby’s arrival. The birth was routine, the baby a healthy, pink-cheeked boy. But a few days after her son’s birth, she sank into the depths of depression. Constantly crying, confused, and feeling incapable of caring for her child, she was experiencing unshakable despair. The diagnosis: a classic case of postpartum depression. Postpartum depression, a period of deep depression following the birth of a child, affects some 10 percent of all new mothers. Although it takes several forms, its main symptom is an enduring, deep feeling of sadness and unhappiness, lasting in some cases for months or even years. Mothers experiencing postpartum depression may withdraw from their family and friends, experience overwhelming fatigue or loss of energy, or feel intense irritability and anger. Furthermore, mothers may feel stigmatized by others (Mickelson et al., 2017; Mohamed et al., 2021). In about 1 in 500 cases, the symptoms are even worse, evolving into a total break with reality. In extremely rare instances, postpartum depression may turn deadly. For example, Andrea Yates, a mother in Texas who confessed to drowning all five of her children in a bathtub, said that postpartum depression led to her actions (Oretti et al., 2003; Misri, 2007). For mothers who suffer from postpartum depression, the symptoms are often bewildering. The onset of depression usually comes as a complete surprise. Certain mothers do seem more likely to become depressed, such as those who have been clinically depressed at some point in the past or who have depressed family members. Furthermore, women who are unprepared for the range of emotions that follow the birth of a child—some positive, some negative—may be more prone to depression (LaCoursiere et al., 2012; Pawluski et al., 2017; Ponting et al., 2020). In some cases, women experience intense anxiety following birth. Although less studied, postpartum anxiety may be even more prevalent than postpartum depression, with some estimates as high as an incidence of 20 percent (Paul et al., 2013; Menkedick, 2020). 109 110 PART 1 Beginnings Postpartum depression and anxiety may be triggered by the pronounced swings in hormone production that occur after birth. During pregnancy, production of the female hormones estrogen and progesterone increases significantly. However, within the first 24 hours following birth, they plunge to normal levels. This rapid change may result in depression (Engineer et al., 2013; Glynn & Sandman, 2014; Hantsoo, 2020). More broadly, pregnancy and birth produce significant changes in the brains of mothers. For example, childbirth leads to dramatic reductions in gray matter of the brain, particularly related to social cognition. The changes in the brain seem to pave the way for emotional attachment to the infant, and the changes are long-lasting (Hoekzema et al., 2017; Barba-Müller, 2019; Hines, 2020). Module 3.2 Review LO 3.4 Describe some of the causes of, effects of, and treatments for preterm births. Largely because of low birthweight, preterm infants may have substantial difficulties after birth and later in life. Verylow-birthweight infants are in special danger because of the immaturity of their organ systems. Preterm and low-birthweight deliveries can be caused by health, age, and pregnancy-related factors in the mother. Income (and, because of its relationship with income, race) is also an important factor. Many preterm babies spend weeks or months in the neonatal intensive care unit receiving specialized care to help them develop. LO 3.5 Identify the risks that postmature babies face. Postmature infants face certain risks, including loss of blood supply and difficult births due to their size. LO 3.6 Describe the process of cesarean delivery and the reasons for its increase in use. Cesarean deliveries, in which babies are surgically removed from the uterus, are performed with postmature babies or when the fetus is in distress, in the wrong position, or unable to progress through the birth canal. The routine use of a fetal monitor has contributed to a soaring rate of cesarean deliveries. LO 3.7 Describe rates of infant mortality and what factors affect these statistics. The overall rate of infant mortality is 5.22 deaths per 1,000 live births. In the United States, Black babies are more than twice as likely to die before age 1 than white babies. Infant mortality rates can be affected by the availability of inexpensive health care and good education programs for mothers-to-be. LO 3.8 Describe the causes and effects of postpartum depression. Postpartum depression affects about 10 percent of new mothers and may be triggered by the pronounced swings in hormone production that occur after birth. Journal Prompt Applying Lifespan Development: Why do you think there is a higher rate of cesarean deliveries among Black mothers than among white mothers? The Competent Newborn Relatives gathered around the infant car seat and its occupant, Kaita Castro. Born just 2 days ago, Kaita is going home from the hospital with her mother. Kaita’s nearest cousin, 4-year-old Tabor, seems uninterested in the new arrival. “Babies can’t do anything fun. They can’t even do anything at all,” he says. Kaita’s cousin Tabor is partly right. There are many things babies cannot do. Neonates arrive in the world quite incapable of successfully caring for themselves, for example. Why are human infants born so dependent, whereas members of other species seem to arrive much better equipped for their lives? One reason is that, in one sense, humans are born too soon. The brain of the average newborn is just one-quarter of what it will be at adulthood. In comparison, the brain of the macaque monkey, which is born after just 24 weeks of gestation, is 65 percent of its adult size. Because of the relative puniness of the infant human brain, some observers have suggested that we are propelled out of the womb some 6 to 12 months sooner than we ought to be. for more ebook/ testbank/ solution manuals requests: email [email protected] Chapter 3 Birth and the Newborn Infant 111 In reality, evolution probably knew what it was doing: If we stayed inside our mothers’ bodies an additional half-year to a year, our heads would be so large that we’d never manage to get through the birth canal (Schultz, 1969; Gould, 1977; Kotre & Hall, 1990). The relatively underdeveloped brain of the human newborn helps explain the infant’s apparent helplessness. Because of this vulnerability, the earliest views of newborns focused on the things that they could not do, comparing them rather unfavorably to older members of the human species. Today, however, such beliefs have taken a backseat to more favorable views of the neonate. As developmental researchers have begun to understand more about the nature of newborns, they have come to realize that infants enter this world with an astounding array of capabilities in all domains of development: physical, cognitive, and social. Physical Competence: Meeting the Demands of a New Environment LO 3.9 Describe the physical capabilities of the newborn. The world faced by a neonate is remarkably different from the one it experienced in the womb. Consider, for instance, the significant changes in functioning that Kaita Castro encountered as she began the first moments of life in her new environment (summarized in Table 3-4). Kaita’s most immediate task was to bring sufficient air into her body. Inside her mother, air was delivered through the umbilical cord, which also provided a means for taking away carbon dioxide. The realities of the outside world are different: Once the umbilical cord was cut, Kaita’s respiratory system needed to begin its lifetime’s work. For Kaita, the task was automatic. As we noted previously, most newborn babies begin to breathe on their own as soon as they are exposed to air. The ability to breathe immediately is a good indication that the respiratory system of the normal neonate is reasonably well developed, despite its lack of rehearsal in the womb. Neonates emerge from the uterus more practiced in other types of physical activities. For example, newborns such as Kaita show several reflexes—unlearned, organized, involuntary responses that occur automatically in the presence of certain stimuli. Some of these reflexes are well rehearsed, having been present for several months before birth. The sucking reflex and the swallowing reflex permit Kaita to begin to ingest food right away. The rooting reflex, which involves turning in the direction of a source of stimulation (such as a light touch) near the mouth, is also related to eating. It guides the infant toward potential sources of food that are near its mouth, such as a mother’s nipple. Not all of the reflexes that are present at birth lead the newborn to seek out desired stimuli such as food. For instance, Kaita can cough, sneeze, and blink—reflexes that help her to avoid stimuli that are potentially bothersome or hazardous. Table 3-4 Kaita Castro’s First Encounters upon Birth 1. As soon as she is through the birth canal, Kaita automatically begins to breathe on her own despite no longer being attached to the umbilical cord that provided precious air in the womb. 2. Reflexes—unlearned, organized, involuntary responses that occur in the presence of stimuli—begin to take over. Sucking and swallowing reflexes permit Kaita to immediately ingest food. 3. The rooting reflex, which involves turning in the direction of a source of stimulation, guides Kaita toward potential sources of food that are near her mouth, such as her mother’s nipple. 4. Kaita begins to cough, sneeze, and blink—reflexes that help her avoid stimuli that are potentially bothersome or hazardous. 5. Her senses of smell and taste are highly developed. Physical activities and sucking increase when she smells peppermint. Her lips pucker when a sour item is placed on her lips. 6. Objects with colors of blue and green seem to catch Kaita’s attention more than other colors, and she reacts sharply to loud, sudden noises. She will also continue to cry if she hears other newborns cry but will stop if she hears a recording of her own voice crying. reflexes unlearned, organized, involuntary responses that occur automatically in the presence of certain stimuli 112 PART 1 Beginnings vlavetal/Shutterstock Kaita’s sucking and swallowing reflexes, which help her to consume her mother’s milk, are coupled with her newfound ability to digest nutrients. The newborn’s digestive system initially produces feces in the form of meconium, a greenish-black material that is a remnant of the neonate’s days as a fetus. Because the liver, a critical component of the digestive system, does not always work effectively at first, almost half of all newborns develop a distinctly yellowish tinge to their bodies and eyes. This change in color is a symptom of neonatal jaundice. It is most likely to occur in preterm and low-birthweight neonates, and it is typically not dangerous. Treatment most often consists of placing the baby under fluorescent lights or administering medicine. The sucking and swallowing reflexes allow newborns to begin to ingest food immediately after birth. Sensory Capabilities: Experiencing the World LO 3.10 Describe the sensory capabilities of the newborn. Just after Kaita was born, her father was certain that she looked directly at him. Did she, in fact, see him? This is a hard question to answer for several reasons. For one thing, when sensory experts talk of “seeing,” they mean both a sensory reaction to the stimulation of the visual sensory organs and an interpretation of that stimulation (the distinction, as you might recall from an introductory psychology class, between sensation and perception). Furthermore, as we’ll discuss further when we consider sensory capabilities during infancy in Chapter 4, it is tricky, to say the least, to pinpoint the specific sensory skills of newborns who lack the ability to explain what they are experiencing. Still, we do have some answers to the question of what newborns are capable of seeing and, for that matter, questions about their other sensory capabilities. For example, it is clear that neonates such as Kaita can see to some extent. Although their visual acuity is not fully developed, newborns actively pay attention to certain types of information in their environment. For instance, neonates pay closest attention to portions of scenes in their field of vision that are highest in information, such as objects that contrast sharply with the rest of their environment. Furthermore, infants can discriminate among different levels of brightness. There is even evidence suggesting that newborns have a sense of size constancy. They seem aware that objects stay the same size, even though the size of the image on the retina varies with distance (Chien et al., 2006; Frankenhuis et al., 2013; Wilkinson et al., 2014). In addition, not only can newborn babies distinguish different colors, but they also seem to prefer particular ones. For example, they are able to distinguish between red, green, yellow, and blue, and they take more time staring at blue and green objects—suggesting a partiality for those colors (Zemach et al., 2007; Skelton & Franklin, 2020). Newborns are also clearly capable of hearing. They react to certain kinds of sounds, showing startle reactions to loud, sudden noises, for instance. They also exhibit familiarity with certain sounds. F