The natural birth process
- vaginal birth through the birth canal
- 3 stages:
- Cervix dilates 10cm so the baby can pass through. Average duration is 3-14 hours
- Baby’s head emerges from the cervix and ends with the baby completely leaving the cervix (15 minutes - 2 hours)
- The placenta and umbilical cord (afterbirth) gets expelled. Painless and usually 20min
Medication given during natural birth
- Narcotics and tranquillisers: affects the whole body to relieve pain and anxiety
- Epidural: reduces pain in the lower body
- Spinal block: anaesthetic delivered directly in the spinal cord which provides fast pain relief for a brief period
The dangers these medication pose towards the still unborn child is unknown, and raises a lot of concern
Caesarean birth
- performed when there are complications during the labour process. Example is a breech birth, where the feet or rump are at the cervix, not the head
- more expensive than natural birth
- infant and maternal mortality rates are significantly higher
- chances of complications during the operation and the hospitalisation period are also factors that need to be considered
Childbirth complications
- Anoxia: umbilical cord doesn’t supply enough oxygen until the baby is able to breath using its lungs. Long exposure can lead to brain damage, learning disabilities and cerebral palsy. Short term exposure has little adverse effects if there is proper postnatal care
- Low birth weight: baby weighs less than the norm. Developed countries <2.5kg, in developing countries <2-1.5kg
- either a preterm baby (less than 37 weeks)
- small for gestational age, where the baby shows growth retardation
Neonatal phase (0-4 weeks) : physical appearance
- head takes of 1/4 of the total body size, in adults it’s 1/8
- neck muscles aren’t strong enough to keep the head upright
- arms and legs are short in proportion to the rest of the body
- susceptible to jaundice (yellow skin colour due to underdeveloped liver)
- weight between 2.5-4.5 kg
- girls weigh 120g less than boys
- baby can lose 10% of its weight in the first few days due to fluid loss, poor digestion and poor food intake. Regain weight at day 5
- average length 45-56cm
- heart rate:
Resting: 80-90bpm
Crying: 170bpm
Normal:120-150bpm
Assessment of new-born baby
- APGAR test (one minute after birth and then again 5 minutes after birth
- a score is given between 0-2
- > 7 is normal
- 4-6 is poor
- 0-3 is dangerous
APPEARANCE (colour)
0- bluish-grey or pale
1- normal colour, but hands and feet are bluish
2- normal colour all over (pinkish colour)
PULSE
0- absent
1- below 100 bpm
2- above 100 bpm
GRIMACE (reflex irritability)
0- no response
1- grimace (facial movement when stimulated)
2- cries, pulls away, sneezes or coughs with stimulation
ACTIVITY (muscle tone)
0- limp
1- arms and legs are flexed with little movement
2- active, spontaneous movement
RESPIRATION
0- absent
1- slow and irregular, weak cry
2- normal rate and effort, strong cry
Neonatal phase: Adjustments to basic life processes
- blood circulation
- respiration
- digestion
- body temperature
- the nervous system
- immunity
Important reflexes of neonates
Sucking reflex (+/- 6 months)
- place finger in mouth or on lips
- the baby should start sucking, as it ensures feeding
Rooting reflex (+/- 5 months)
- stroke the babies cheeks
- they should turn their head in the direction if the stimulus, helping them find the nipple and start sucking
Moro reflex (+/- 4-6 months)
- make a sudden loud noise
- the baby should stretch out their arms and legs, and bring back their arms to midline in a self-embracing movement
- this may help the baby cling to caretaker, absence may indicate neurological dysfunction, and continuation after 9 months indicate retardation
Grasping reflex (+/- 4 months)
- touch the palm of their hand
- baby should grasp object firmly
- may help baby to cling to caretaker and prepares baby for voluntary grasping
- absence may indicate neurological defects
Swimming reflex (+/- 6 months)
- place baby with stomach under water
- they should display swimming movements in an attempt to survive
- absence may indicate neurological defects
Walking/Stepping reflex (+/- 3 months)
- hold baby up vertically with feet touching horizontal surface
- they should make walking movements, as this prepares them for voluntary walking
- absence may indicate neurological defects
Babinski reflex (+/- 6-12 months)
- stroke sole of foot
- toes should spread out like a fan
- its significance is unknown, but absence or later occurrence may indicate neurological defect
Neonatal phase: Perception (Senses)
Vision
- 20-40 times more visual acuity, meaning ability to distinguish between closely related elements in the visual field
- they can only properly see within a range of 20-25 cm
- eye muscles are underdeveloped, and far objects is a blur
- can recognise mother’s face after 1-2 weeks
- their cones (colour cells) are underdeveloped, and see in black and white
- will see red first, and the full spectrum of colour will be developed at 4-5 years
Hearing
- within a few hours, the baby can distinguish the mother’s voice
- prefer high-pitched sounds (mother’s voice) to low-pitched sounds (father’s voice)
Smell
- can perceive and distinguish between smells
- pleasant smells stimulate sucking motions
- can distinguish between the breasts of the mother and that of a stranger by smell
Taste
- can distinguish between sweet, bitter and sour, and show a preference for sweet tastes
- can detect tastes from their mother’s milk
Pain
- experience is similar than and adult’s
Neonatal phase: Sleeping and Dreaming
- sleep 16-18 hours per day
- half of their sleep is REM
- this is because it fulfils a function in the normal maturation of the central nervous system and plays a crucial role in brain development, cognition and behaviour
Neonatal phase: Feeding
- eat 8-14 times a day, with intervals of 1.5 - 5 hours
Benefits of breastfeeding
- antibodies protects baby against a variety of diseases
- nutrients stimulate brain growth and myelination of axons
- more easily digestible, reducing the chances of constipation and diarrhoea
- gain less weight and are leaner after a year of breastfeeding, prevents obesity
- avoids malocclusion, where the upper and lower jaw doesn’t properly meet, which is more prevalent in babies who are bottle-fed
- infant doesn’t require other foods until 6 months
- accepts solid foods more easily
- mother’s have a lower incidence of breast and ovarian cancer
Infancy: General physical development
- proceeds in a sequential and predictable pattern, called the cephalocaudal principle
- skills progress from cephalic (head) to caudal (bottom), from proximal (near) to distal (far)
- from generalised, stimulus-based reflexes to specific goal-oriented reactions that become increasingly precise
- rapid changes in weight, and skeletal and muscle growth
- the fontanel closes (soft tissue between the bones of the skull)
- teeth begins to appear within six to eight months
- nervous system grows rapidly in the first two years
Infancy: Gross Motor development
- responsible for the coordinated movement of large muscle groups
- crawling, sitting, standing, walking, running and balance
- ultimate goal is to gain independent voluntary control
- as the central nervous system develops, reflexes start to disappear and the infant starts to make more purposeful movements
- disappearance of asymmetric tonic neck reflex makes it possible to roll over, bring the hands to the midline and reach for an object
- the disappearance of the moro reflex (4 months) makes it possible for the infant to hold the head steady and eventually sit in a seated position unsupported
- Postural reactions start to develop, which allows the infant to protect themselves when falling by correcting their posture
- added balance responses develop during the second year after birth
- 6-9 months: move into a seated position and then to hands and knees
- 9 months: pull to stand
- 12 months: begin walking
- crawling is not a prerequisite for walking
- age 2: child can kick a ball, jump with both feet of the floor and throw a ball
Infancy: Perception
Depth perception
- most babies between 6-14 months can perceive depth
- matures sooner than their motor development does
Visual constancy
- objects appear the same to us despite variations in sensory input
- we know that a car driving away from us isn’t shrinking just because it’s getting smaller within our vision
- present in babies older than 18 weeks
Other
- focusing ability: three months
- visual acuity: 12 months
- colour perception: 6 months
- face perception is initially very general but progressively becomes more specific to faces to which the infant in exposed (perceptual narrowing)
- use intermodal perception which is a process of integration and coordination of information from multiple sensory systems
Auditory perception
- babies of 6 months already have reasonably well-developed auditory perception and can recognise their own names
- neonate: 60 decibels
- three months: 43 decibels
- eight months: 34 decibels
Infancy: Brain development
- develops from the bottom up
- during the first year, the infant’s brain doubles in size, and by the end of infancy it has reached 75% of its adult volume
- areas that sustain life develops first (7 months after conception), primary motor areas develop earlier than the primary sensory areas. Frontal lobes take longer, with the prefrontal lobe taking the longest
- synapse formation peaks in first year of life. Synaptic pruning occurs mostly in the visual system. Neural pathways strengthen as they acquire new skills
- new dendrites grow and synaptic connections between axons and dendrites increase
- myelination occurs, which is necessary for clear, efficient transmission of electrical impulses
- myelin insulates brain circuits, keeping the impulses flowing along their intended pathways
- myelinated axons transmit impulses much faster and more efficiently than non-myelinated axons do and thus ensures rapid neural conduction to the brain
Infancy: Fine motor development
- involved to use the upper extremities (hands, arms and fingers)
- used when one needs to make smaller, more precise movements
- grasps at 5 months
- can pick up an release at 10 months
- at month 15 they can stack a few blocks, they can adjust objects after grasping them and adjust a spoon to eat
- at 2 years they can feed themselves, remove clothing and turn doorknobs
- at 3-4 years hand preference is established
