Unit 2 PRENATAL, PERINATAL,

AND POSTNATAL
DEVELOPMENT

PRENATAL DEVELOPMENT

Prenatal development is the term given to the process of gestation that an embryo
undergoes, right from the fertilisation stage to childbirth. The prenatal period is one of
the most fascinating stages of our development. Its end is marked by a beginning; the
birth of a newborn baby. The prenatal period encompasses the most rapid phase of
development of our lives, beginning as a single cell and ending as a newborn baby
emerging into the world. Development during this time is considered as proceeding
largely under genetic control and immune to external influences. However, as
technology has advanced and scientists have become more sophisticated in examining
the fetus, it has become apparent that development during this time is far from a simple
question of genetically determined growth. Environmental agents may adversely affect
the development of the fetus, and moreover the environment may determine the
functional capacity of the organs of the body. The actions and reactions of the baby will
shape its own development.

Definitions
i) The Prenatal or Antenatal development is the process in which an embryo or fetus
(or foetus) gestates during pregnancy, from fertilisation until birth. Often, the terms
fetal development, foetal development, or embryology are used in a similar sense.
ii) Perinatal (from Greek peri, “about, around” and Latin nasci “to be born”) defines
the period occurring “around the time of birth”, specifically from 22 completed
weeks (154 days) of gestation (the time when birth weight is normally 500 g) to 7
completed days after birth.
iii) The antepartum period (from Latin ante “before” and parere “to give birth”) is
literally equivalent to prenatal (from Latin pre- “before” and “to be born”).
Practically, however, antepartum usually refers to the period between the 24th/26th
week of gestational age and birth of a child.
iv) Postnatal period begins immediately after the birth of a child and then extends for
about six weeks. During this period the mother’s body returns to prepregnancy
conditions as far as uterus size and hormone levels are concerned.
 PRENATAL PERIOD

A child takes about 9 months or 40 weeks to reach the stage of birth, and in this time
period, a lot of changes and processes occur to the child’s body and the mother’s body
as well. The prenatal development stages outline the growth of the child and give a
clearer picture of the development of the child in the womb.

The Period of Prenatal Development

The stages can be divided into three parts, and each part carries its own significance and
importance in the development of a fetus. These are the period of the Zygote, period of
the Embryo and the period of fetus.
i) Period of the Zygote (fertilisation to end of second week)
 The size of the zygote-that of a pinhead- remains unchanged because it has no
outside source of nourishment and is kept alive by yolk in the ovum.
 As the zygote passes down the Fallopian tube to the uterus, it divides many
times and separates into an outer and an inner layer.
 The outer layer later develops into the placenta, the umbilical cord, and the
amniotic sac, and the inner layer develops into a new human being.
 About ten days after fertilisation, the zygote becomes implanted in the uterine
wall.

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 

ii) Period of the Embryo (end of the second week to end of the second lunar month)
 The embryo develops into a miniature human.
 Major development occurs, in the head region first and in the extremities last.
 All essential features of the body, both external and internal are established.
 The embryo begins to turn in the uterus, and there is a spontaneous movement
of the limbs.
 The placenta, the umbilical cord, and the amniotic sac develop and protect and
nourish the embryo.
 At the end of the second prenatal month, the embryo weighs 1.25 ounces and
measures 1.5 inches in length.
iii) Period of the Fetus (end of the second lunar month to birth)

 Changes occur in the actual size of the parts already formed and in their
functioning. No new features appear at this time.
 By the end of the third lunar month, some internal organs are well developed to
function. Fetal heartbeat can be detected by about the fifteenth week.
  By the end of the fifth lunar month, the different internal organs have assumed
positions nearly like the ones they will have in the adult body.
 Nerve cells, present from the third week, increase rapidly in number during the
second, third and fourth lunar months. Whether or not this increase will
continue will depend upon conditions within the mother’s body such as
malnutrition, which adversely affects nerve cell development – especially
during the latter months of the prenatal period.
 Fetal movements first appear between eighteen and twenty two weeks and then
increase rapidly up to the end of the ninth lunar month when they slow down
because of crowding in the amniotic sac and pressure on the fetal brain as the
fetus takes a head down position in the pelvic region in preparation for birth.
These fetal movements are of different kinds – rolling and kicking and short or
quick
 By the end of the seventh lunar month, the fetus is well enough developed to
survive, should it be born properly.
 By the end of the eighth lunar month the fetal body is completely formed,
though smaller than that of a normal, full – term infant.

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PRE-NATAL DEVELOPMENT
CONCEPTION
Conception occurs from the union of a male reproductive sex celi called the sperm, with female
reproductive sex cell calle1 the Ovum. The female ovaries produce Ova whereas sperns are
prcduced in testis.
Fallopian Tubes: Tubes that transport the ova from ovaries to the uterus.
Estrogens: A group of feminizing hormones produced by the Ovaries and to some extent by the
adrenal glands in both males and females.
Gonads: .The sex glands that regulate sex drive and the
physiological changes that accompany physical maturity; the ovaries
in the female and the testes in the male.
Fertilization: Fertilization is union of sperm and ovum and it leads to conception. Life begins at the
moment of conception i.e. the time when a female reproductive cell -the ovum is fertiized bya male
reproductive cell- the spermatozoon. In females, egg cells/ovum develops in ovaries whereas male
reproductive cells (spermatozoa or sperm cells) develop in testes. Spermatozoa in large rumber are
deposited from the male at the mouth of the uterus and they start travelling towards the fallopian
tubes. They are attracted towards the ovum by strong hormonal force, which draws them into tube.
The
Surface of the ovum changes when one sperm cell enters and no another sperm cell can enter
afterwards. This union of two cells to form One cell is known as "Fertilization". The fertilized cell is
quickly
foliowed by cell division and then the zygote ravels towards uterus and gets implanted within the
uterus. Conception/fertilization occurs approximately 280 days before birth. Each normal male and
female cell has 46/23 pairs of chromosomes and each chromosome contains thousands of genes.

Chromosomes: Chromosomes are rod like structures in each sperm or egg cell. They occur in pairs
and carry the hereditary material, dot like structures called genes.
Genes: are strings of microscopically small particles located at specific positions in chromosomes.
They constitute the physical substance passed on from parents to off springs. They are the carriers of
hereditary traits. Genes are made up of numerous molecules called
DNA-deoxyribonucleic acid.
Genes always work in pairs and are located in corresponding positions on the chromosome pairs.
Each cell of body has the same DNA code and the same genes direct an individual's growth. The
particular code that we inherit from our parents directs our growth as humans rather than any other
creature and is responsible for all the physical characteristics we develop. Each sperm cell and each
ovumcell contains 23 chromosomes. 22 of these are called autosomes that are responsible for most
aspects of the individual's development. 23rd pair is called sex chromosome, which determines
whether the offspring
will be a male/ female. When the ovum and sperm cell unite to form a single new cell it is called
zygote. When one sperm attaches itself to the surface of the ovum, there is a biochemical reaction on
the
Ovum's Surface that prevents any other sperm to attach. Slowly the sperm penetrates the ovum and
within few hours new zygote is formed. During these process two types of cell divisions takes place
namely, Mitosis and Meiosis. Mitosis and Meiosis describes the process by
which the body prepares cells to participate in either asexual or sexual
reproduction to make an entire organism.
Mitosis: (for other cells) Mitosis is the reproduction of skin,
heart, stomach, cheek, hair cells. These cells are "Autosomal" cells.
This is also a form of "Asexual" reproduction, where one organism or
cell reproduces itself. Chromosomes duplicate themselves and divide.
TWo sets of chromosomes move to opposite side of the cell. A wall
is formed and eventually two cells are formed. This process goes on
Continuously in all tissues from conception till death.
Meiosis: (for sex cells) Meiosis is the production of sperm and egg cells. These cells are "Gamete" or
"Sex' cells. Each cell has to go through the division process twice in order for the cell to end up
with half the number of chromosomes. The cells pass on genetic Information to the offspring. This is a
form of "Sexual" reproduction, Where one organism or cells reproduces by crossing with another
organism or cell. Each chromosomes duplicates and pair with one another. Crossing over takes
places between the two innermost pairs.
The pair of chromosomes separates to form two cells each with 23 duplicate chromosomes. The
duplicate chromosomes separate to to gametes, each with 23 single chromosomes.
During conception half of the chromosomes are inherited from
father and half are inherited from the mother. Therefore iron two parents, the child receives a new
combination of parental genes. Due to this new combination, a child may have many traits in common
with one, or both of his parents, as well as he may resemble one of the grand parents / great grand
parents.
Fertilization determines four points
1. Heredity endowment: At the time of conception or the moment sperm unites with the ovum,
everything a newborn will ever inherit is determined. There are 20,000 to 1, 00,000 gene mature cell
and a similar number in mature ovum. It is a rer
of chance, how much a newborn inherits from his true parents as well as from the ancestors.
Hereditary endowment cannot be changed after conception. Nothing can be done to add or subtract
anything to his inheritance. There are two types of inheritance- Dominant and Recessive. Law of
dominant inheritance that
says that when an organism inherits competing traits, only one
trait is expressed explains dominant inheritance. The trait that is
expressed is dominant over the other. Dominant trait is determined
by dominant genes. Recessive genes have less' influence.

(i)Phenotype: A trait that is observable in an organism is called phenotype. It refers to child's actual
appearance and
behaviour e.g. how tall he/she becomes. The actual height gained by an individual is phenotype.
(i) Genotype: It is the underlying genetic pattern in an
organism. It refers to child's potential/ his inborn capacity to
grow specially height, weight, colour of eyes etc.
2. Sex of the child: Sex of the child is determined at the time fertilization. Discovery of sex
chromosomes has shown the man produces two types of sex chromosomes ie. X and Y. X
chromosomes with a larger head and shorter tail and Y- chromosomes with a smaller head and
longer tail. A woman produces ova with X chromosomes only. If a sperm containing an X
chromosome unites with ovum a girl is conceived. If a sperm containing Y-chromosomes unites with
ovum a boy is conceived.

Therefore it is the father who is responsible for the sex of children of each sex will be conceived
because Y carrying child. According to law of chance, approximately an equal number sperm have a
longer tail & lighter head. Due to this they swim faster and may reach the
egg cell sooner but they have shorter
life span and are vulnerable to destruction, Therefore, the ratio is 105 males to 100 females born
alive.

Single/Twins births: Whether the birth will be single or multiple is also decided at the time of
conception. Singleton is a child
who is born alone, Multiple births refer to the birth of two or more babies within a few hours.

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There are two types of twins:
i) ldentical twins (Monozygotic): a sperm fertilizes an ovum but it divides during development to
produce two embryos, Which have the same heredity, same sex and usualy share
a common placenta.
(1) Fraternal twins (Dizygotic): Two separate sperms fertilise two ova and the two embryos may or
may not be of same Sex. They are different in heredity as any other siblings with separate placenta.
Physical characteristic and mental similarities are more striking in identical twins than in non identical
twins. Mental similarities are reported to persist till old age.
Ordinal position: The fourth thing that happens at the time of conception is the establishment of new
child's ordinal position among siblings.
2.2 ALTERNATIVE METHODS OF CONCEPTION
Some couples decide not to risk pregnancy because of a history
of genetic disease. Today, increasing numbers of individuals are turning
to alternative methods of conception. This technology has become the subject of heated debate.
Donor insemination and in vitro fertilization.
Approximately one in eight infertile couples require the use of donor sperm to achieve a pregnancy.
Donor insemination is a
simple procedure that uses a syringe to place semen into a Woman's vagina to assist her in getting
pregnant. The semen is obtained from someone other than the woman's husband or partner.
Donor insemination is a safe method. The donors go through complete medical examinations, which
include thorough screenings for sexually transmitted diseases, the presence HIV antibodies and
history of genetic disorders. A pregnant
resulting from donor insemination is as safe as a pregnant resulting from intercourse.
In vitro fertilization is another reproductive technology that have become increasingly common. Since
the first "test tube" baby was born in England in 1978, thousands of infants have been created this
way. For in vitro fertilization, hormones are given to a woman, stimulating ripening of several ova. The
ova removed surgically and placed in a dish of nutrients, to which sperms are added. Once an ovum
is fertilized and begins to duplicate into
several cells, it is injected into the mother's uterus, where, implants and develop. In vitro fertilization
is usually used to treat women whose fallopian tubes are permanently damaged, and it is successful
for 20 percent of those who try it. By mixing and matching gametes
(reproductive cells), pregnancies can be brought about when either or both partners have a
reproductive problem. In cases
where couples might transmit harmful genes, single cells can be plucked from the duplicating zygote
and screened for hereditary defects. Fertilized ova can even be frozen and stored in embryo banks
for use at some future time, thereby guaranteeing healthy zygotes to older women. Children
conceived through these methods may be genetically unrelated to one or both of their parents. It has
been found that lack of genetic ties do not interfere with parent-child relationships.
A recent study found that quality of parenting was superior (warmer and more emotionally involved)
for 4 to 8 years olds
conceived through in vitro fertilization or donor insemination than for naturally conceived children. A
strong desire for parenthood among couples who have experienced reproductive probably
seems to enhance family functioning. Though donor insemination and in vitro fertilization have many
benefits but few very serious questions have been aroused about their use. Many states have
no legal guidelines for these procedures. As a result, donors are not always screened for genetic or
sexually transmitted disease.
Surrogate motherhood
A more controversial form of medically assisted conception is surrogate motherhood. Typically in this
procedure, sperm from a man whose wife is infertile are used to inseminate a woman,who is paid a
fee for her childbearing services. In return, the Surrogate agrees to return the baby over to the man
(who is the
natural father). His wife then adopts the child. Intended parents may arrange a surrogate pregnancy
because a woman who intends to parent is infertile in such a way that she cannot carry a pregnancy
to term. Examples include a woman who has had a hysterectomy, has a uterine malformation, has
had recurrent
pregnancy loss or has a health condition that makes it dangerous for her to be pregnant. A female
intending parent may also be fertile and healthy. but unwilling to undergo pregnancy. Alternatively, the
intended parent may be a single male, or a
male homosexual couple. India is emerging as a leader in international surrogacy. Commercial
surrogacy has been legal in India since 2002 but
there is no clear cut law regarding it. The Indian Council of Medical Research (|CMR) - the health
ministry's research wing- has already drafted a model law, which will be studied by the Women and
Children Development ministry before being forwarded to the Union Cabinet. Surrogacy in India is
unregulated
although the Indian Council of Medical Research has set "national guidelines" to regulate surrogacy,
these are simply
guidelines.
Few problems are associated with donor insemination and in vitro fertilization. Although most of these
arrangements proceed smoothly, still few problems highlight serious risks for all concerned e.g. In
one case the father rejected the handicapped infant that resulted from the pregnancy. In another
case, the
surrogate mother changed her mind and wanted to keep the baby. Another problem is that most
surrogate mothers already
have children of their own, who may be deeply affected by the pregnancy. Knowledge that their
mother would give away a baby for profit may cause these youngsters to worry about the security
of their own family circumstances.
2.3 GENETIC COUNSELLING
Genetic counselling helps couples to assess their chances of giving birth to a baby with a hereditary
disorder. Genetic counselling is reguired when there is history of repeated miscarriages or when
genetic problems exist in families or when mental retardation, physical defects or inherited diseases
are present in the relatives. The genetic counsellor interviews the couple and prepares a picture of
the family tree in which affected parents are identified. The tree is used to
estimate the likelihood that parents will have an abnormal child.

Prenatal Diagnostic Methods:

Prenatal diagnosis is the process of determining the condition a foetus before it is born. This type of
diagnosis has become important part of pregnancy care. The earliest form of prenatal testing was vey
simple. The mother noted foetal activity in the womb, and the doctor manually felt the unborn child
through the mother's abdomen. Eventually machines were developed for listening to the foetal
heartbeat.

Methods currently in use:

1.Amniocentesis: It is the most widely used technique. A hollow needle is inserted through the
abdominal wall to obtain a sample of fluid in the uterus. Amniotic fluid could be analyzer chromosome
disorders like Down's syndrome. To amniocentesis permits the diagnosis of a wide range of
disorders. Amniocentesis is normally recommended at fourteen to sixteen
weeks of pregnancy. Test results are usually available to the patient in two to three weeks. It involves
small risk of miscarriage.
2. Chorionic villus sampling: Chorionic villus sampling is when samples of foetal tissue are
retrieved from the foetus. The
samples are then analyzed for chromosomal, biochemical and

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DNA content. This procedure can be used if results are desired or needed at an early stage of
pregnancy. A thin tube is inserted
into the uterus through the vagina or a hollow needle is inserted through the abdominal wall. A small
plug of tissue is removed from the end of one or more chronic villi (the hair like projections
on the membrane surrounding the developing organism). Cells are examined for genetic defects. It
involves slightly greater risk of miscarriage than does amniocentesis. It is also associated
with a small risk of limb deformities. The risk is higher if the procedure is performed early.
3.Ultrasound: Ultrasound scanning has become the most popular method of prenatal testing.
Ultrasound uses sound waves to produce a picture of the developing foetus that reveals the size,
shape.and placement of the foetus. It has no known harmful effect on the mother or the unborn child
and requires nO probing
or biological samples to be taken. It permits assessment of foetal age, detection of multiple
pregnancies, and identification of gross physical defects..
4.Fetoscopy: In this a small tube witha light source at one end is inserted into the uterus to inspect
the foetus for defects of the limbs and face. It involves Some risk of miscarriage.

5. Measuring Alpha-Fetoprotein (AFP): Another prenatal diagnostic test now given to most
pregnant women measures
maternal serum alpha-fetoprotein (MSAFP) levels. This test
samples the mother's blood for the amount of AFP. AFP is a protein produced by the foetal liver and
is associated with Down's
syndrome.
6. Foetal blood sampling: The blood sample is used to diagnose
a variety of hereditary blood disorders. The samples of blood are
taken from the umbilical cord.
Reasons for prenatal diagnosis
7.DNA Analysis: DNA analysis for specific gene disorders was introduced to prenatal testing in 1976.
DNA from a number of
different sources is examined. These sources include foetal samples plus maternal and paternal
blood samples. This allows the doctors to identify genetic problems that might be transnitted
by either parent. Over 260 single gene defects can now be diagnosed through DNA analysis.
Reasons for prenatal Diagnosis
There are three purposes of prenatal diagnosis:

i) To enable timely medical or surgical treatment of a condition before or. after birth,
ii) To give the parents the chance to abort a foetus with the diagnosed condition,
iii) To give parents the chance to prepare for a baby with a health problem or disability, or for the
likelihood ofa stillbirth.
Knowledge of this information in advance means that healthcare staff can better prepare
themselves as well as the parents for the delivery of a child with a health problem. It is
important to remember that no prenatal test can detect all forms of birth defects and abnormalities.
Prenatal testing is recommended to
Women over the age of 35
(ii) Women who have previously had premature babies or babies
with a bith defect, especially heart or genetic problems
(ii) Women who have high blood pressure, lupus, diabetes, asthma,
or epilepsy
(iv) Women who have family histories or ethnic backgrounds prone
to genetic disorders, or if their partners have such histories.
(V) Women who are pregnant with multiples (twins or more)
(vi) Women who previously had miscarriages
Significance of Prenatal Period

Significance for the Mother: Events prior to birth are normally Considered unimportant but it is very
important from the health point of the mother because:

i) If regular checkups are done, expected abnormal deliveries can be identified and the complication at
the time of delivery can be copied up with.
ii) Mother can be helped to discard fear and overcome anxiety about the child to be born.
iii) During this period all important nutrients are passed on to the foetus from the mother's blood
stream through the placenta thus, a well balanced and nutritious food is required for the malnutrition
can lead to tooth decay, weakness of bones, of natural immunity.

(iv) Some diseases are passed on to foetus from mother blood stream e.g. Syphilis, Diphtheria, etc. So,
it is very important to protect pregnant lady from these diseases.
(V) It is important for the pregnant lady to stay away from and smoking, as it is disastrous for the
health of the motl
well as the growing foetus.

Significance for the child: Prenatal period is most vital for the growth and development of child as:
i) Various disease and abnormalities can be identified during period with the help of various modern
diagnostic aids.
ii) Child acquires immunity which remains for three months the birth.
(iii) Child's nutritional requirement is met from the mother's baby stream through placenta. Therefore,
if mother suffers from
malnutrition or other disease, the child is likely to suffer from same frequently after birth.
2.5 SIGNS AND SYMPTOMS OF PREGNANCY
There are numerous signs of pregnancy which appear sooner later. All pregnant women experience one
or more of those going to doctor.

i) Amenorrhea (missing a period): The first sign of pregnancy a missed period. If the woman has a
regular cycle and are ovum ten days late, it is possible that the conception has occurred. However, it is
advisable to consult the doctor as sometime menstrual period may be missed due to anxiety, emotional
ups
or an illness., Pregnancy tests done on urine are the confirmation tests.
ii) Morning Sickness: It causing restlessness and vomiting morning/waking time. It is another sign of
pregnancy. toccur in 50 per cent women due to the changes in the hormone balance i.e. increase in
estrogens. It starts 2-3 weeks after the first missed period. It may occur at any time of the day. It may
be mild severe for some women whereas and some women may never experience it at all. It is normal
and should not cause concern unless it leads to frequent vomiting.
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3 Changes in Breast: Right from the very beginning of pregnancy breasts become tender and grow
larger. Breast size increas
and lady feels heaviness and tightness. Nipples are fuller and firmer. Areola (area around nipple)
becomes darker. Nature
prepares for the day the baby will be born and will need feeding. Nipples grow a little, so that they will
be of a size the baby can
grasp when.

4. Frequent Urination: Increase in frequency of passing urine is another common sign. It is due to the
irritation of the bladder by the nearby growing uterus during early days of pregnancy. In the later stage
it can be due to pressure on urinary bladder by enlarged heavy womb/uterus. Unless passing of urine is
not accompanied by a burning sensation, there is no need to worry.

5. Enlargement of abdomen: Abdomen starts increasing in size & becomes prominent after three
months, due to growth of the fetus inside the womb of mother. The movements of foetus are
not strong enough to be aware of them until 4 or 5 months.
6.Quickening: Movement of the child inside the mother's womb is known as quickening. Mother can
feel this movement at the end of fifth month in first pregnancy & little earlier in subsequent
pregnancies.
7.Mucus Discharge: Increase in the normal amount of mucus
discharge from vagina is normal provide it is not irritating or foul
smelling.
8. A change is taste: Most of the women develop strong likes and dislikes of certain food during
pregnancy. This is because of increase in secretion of hormones in body during pregnancy.

2.6 DISCOMFORTS DURING PREGNANCY

Pregnancy is a complicated process & needs very delicate handling. Many women go through the
whole period of pregnancy very cheerfully. Some may, however, have various discomforts, which
can be lessened by proper care.

Nausea and Vomiting: The most common minor discomfort of pregnancy is morning sickness, which
usually occurs immediately after women gets up in the morning but may feel nausealvomiting
at other times of the day also, Nausea is very common during first 3 months mainly because of the
hormonal changes in body.
If a pregnant lady develops fear & anxiety about the sex of the child, it becomes an acute problem.
Empty stomach is also
responsible for nausea. .It becomes mild by the end of third month except in some ladies. In few cases
profuse and prolonged vomiting is a serious condition and help of doctor required.
Precautions:
i) Pregnant lady should take it as a natural process. She should keep herself occupied and should not
keep herself anxious worried or fearful.
(ii) She should never remain empty stomach. She will probably feel more comfortable if she eats
small meals fairly often, rather the two or three large meals a day. The diet should be nutritious and
easily digestible.
(iii) To get rid of morning sickness few biscuits or roasted chana
etc can be eaten before getting out of bed. A glass of limewate in the morning is also helpful.
(iv) Proper rest & sleep are important.
(v)In case of severe constipation milk of magnesia after meals is helpful.
(vi)If the problem continues for a long period and the vomiting an frequent than doctor should be
consulted but no drug without advice should be taken.
2.Miscarriage/threatened Abortion: For some reasons the lining of the uterus rejects the growing
foetus. If the developing cell is not firmly attached to the lining of the uterus it will be thrown out
together with the rest of the lining with fairly heavy blood loss.
The pregnant women should take complete bed rest with food end raised. If there is a bloodstained
discharge or spasms of pain in lower abdomen then she should consult the doctor immediately.
Precautions
(i) Complete rest is important
(ii) Avoid lifting heavy weight
(iii) If bleeding or pain persists, consult doctor immediately.
3. Heartburns and Indigestion: Heartburn in fact is a form of indigestion. It is the burning sensation
below the breastbone. It may be due to pressure of the uterus on stomach or heart. The digestive
problem is more common during last three months because of the large quantity of acid retained in
stomach. Spicy and fried foods are also responsible for frequent acidity and indigestion.
(i) Avoid spicy and fried foods
(ii) Drink cold milk at short intervals.
(iii) Take dinner 3 to 4 hours before going to bed.
(iv) Occasional use of antacids is recommended.
4.Constipation: In pregnancy high level of progesterone slows down the passage of food along the
bowel. More water is drawn from the stools and the stools become harder which causes
constipation. Other causes may be lack of fibrous foods, faulty & irregular toilet habits and weak
intestines.
Precautions:
(i)More intake of water & fluids
(ii) Include roughage and lots of green leafy vegetables in daily diet
(iii) More salads and raw vegetables should be consumed

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(iv) Regular toilet habits
(v) Long evening & morning walks are helpful
(vi) Purgatives should not be used regularly without consent of doctor
5. Varicose veins and Piles: Sometimes certain veins in the legs
become swollen and painful called varicose veins. The veins dilate and collect more blood in
circulation that puts an extra strain on them. The second common site is around the anus
called piles.
Precautions:
(i)Lying down as often as possible during the day may help enlarged
veins.
(ii) Avoid standing for along period
(iii) Undertake simple exercises of ankle
(iv) Put feet high, with pillow underneath
(v) Avoid stockings with tight band above
(vi) Wear long socks throughout day
(vii) Try to rest your foot on a footrest
(viii) For varicose veins of the anus avoid constipation, take more
laxatives.
6. Fainting and Giddiness: Fainting and giddiness is also common
in pregnancy. The total volume of blood during pregnancy is
increased by 20 percent while the total number of red blood cells is not increased at all. Since it is the
red blood cells that pick oxygen and carry it to the brain, therefore the increased volu
of, blood results in fainting. Sometimes low blood pressure also responsible for it.
tiredness; standing for long time, sudden change in position
Precautions:
(1)Get Blood pressure checked regularly
(ii) Do not stand for too long
(iii) Take proper rest
(iv) Wear loose and comfortable clothes.
(v)Avoid stuffy, crowded and airless rooms.
7. Aches and Pains: This is common, especially in the later mont
of pregnancy. During pregnancy the ligaments, which hold the joints together, becomes loose. With
advancement of pregnancy abdominal muscles stretch and cause pelvic pains. Pelvic
lasts for a very short period and is common during the third trimester. It can also be caused because of
uncomfortable shoe and clothes.
Precautions:
(i)Avoid high heels
ii) Prefer comfortable clothing
iii)Take proper rest
iv)Sleep on a firm based bed
v)Should stand and walk in a correct posture of body
8. Backache: It is a very common problem and is faced by almost 100 per cent pregnant ladies. It is
caused by unusual pressure strain exerted on the back due to enlarged abdomen. Sometimes
it can be there because of general weakness of muscles.
Precautions:
(i) Regular rest periods are important
(ii)Correct posture while sitting and standing
(iii) Avoid lifting heavy weight
(iv) Use hot water bottle
(v) Avoid standing for long periods
(vi) Consult doctor if pain is
FACTORS AFFECTING DEVELOPMENTAL IRREGULARITIE
Mother's Age: The age of mother affects foetus development
The recommended age for mothers to conceive is between 18 to 35 years. Reproductive organs of the
mothers who are less tha 18 years are not fully mature and the hormones required fc
reproduction are not at optimum level. Such mothers are at high risk for complications during
pregnancy. Similarly after the age of 35, hormonal activity gradually decreases which may lead to
complications. Women over the age of 40 run a risk of having children with chromosomal abnormality,
particularly the Down's syndrome that leads to mental retardation.
Maternal Nutrition: Growing foetus's food supply comes from
the mother's blood stream via the placenta and the umbilical Cord. The child receives its nutrition from
what the mother eats.
For the healthy development of the child during the pre-natal stage, it is very important that mother
takes balanced diet.
Thus, it is very essential that pregnant mother's diet should contain
necessary food elements like protein, fats, carbohydrates, vitamins, minerals etc. Serious malnutrition
of the mother leads to maternal deficiency or some physical abnormality such as rickets, nervous
instability, general physical instability, epilepsy
etc. She needs to take about 300 calories more than she was taking earlier. She gains about 12 kg. of
weight during pregnancy.
52
3.Maternal Health/diseases: Any disease condition of influence the development
from anemia, diabetes, the mother that affects her general metabolism will of her unborn child.
Mothers who suffer heart ailments, endocrine disorder, or any infectious disease are Endocrine
disorder especially cretinism. Endocrine likely to influence the unborn child. in the case of thyroid
deficiency results in imbalances also result in Microcephaly and Mongolianism Infections diseases
such as syphilis, gonorrhoea, poliomyelitis and rubella etc. will cause blindness, deafness, and mental
deficiency, Drugs like quinine cause deafness in the child. Use of X-ray and radium during pregnancy
can cause microcephaly.
AIDS (Acquired Immune Deficiency Syndrome) currently threatens
the lives of a growing number of unborn and newborn babies. Mothers
with AlDS can pass the virus to their babies, either across the placental
barrier during pregnancy or in some cases, by breast feeding too.

4.Un-prescribed Drugs, Alcohol and smoking: Many a times

pregnant women start taking medicine without realizing its impact
on the foetus. It can be harmful or even prove fatal to the unborn
child. Many drugs are suspected of producing birth defects when
taken during pregnancy. These include some antibiotics,
hormones, steroids, anticoagulants, narcotics, tranquillizers, and
possibly some hallucinogenic drugs.
Use of alcohol by mother will cause nervousness and
regular heartbeat. Drinking by pregnant women can produce foetal
alcohol syndrome. Use of Tobacco or Cigarette smoking by the mother increases the foetal heart rate.
Excessive intake of caffeine
cah cause abortion, still birth, and premature birth of the child.
5. Exposure to X-rays: During pregnancy, unnecessary exposure
to X-ray without doctor's advises should be avoided. Exposures
to radiation during early conception period may lead to congenital
birth defects as well as have harmful effects on the physical and
mental development of the foetus..
6. Maternal Emotions: Severe and prolonged emotional tensions
during the period of pregnancy could cause physical or mental malformations.
7. Uterine Crowding: In multiple births, the crowding in the uterus may cause premature births,
neonatal deaths or congenital malformation
Environmental Pollution: 8.Environmental pollution is another
factor that affects the pre-natal development. Pregnant women
can absorb lead from car exhaust, paint flaking of the walls in
old houses and other building materials .The high levels of lead
exposures are consistently linked to low birth weight. brain
damage and variety of physical defects. Affected babies show
poor mental development during the first two years.
2.12 BIRTH PROCESS AND TYPES OF BIRTH
1 The process of childbirth or labour pain starts with the regular
contractions of the uterine muscles. At first the pain starts at the back
and moves in front. These contractions will cause the foetus to descend. The most common is the
normal birth in which the head emerges first followed by trunk and legs. Sometimes the doctors have
to use forceps. In breach birth child's buttocks appear first followed by legs and head, Sometimes the
child dies before the birth it is known as stillbirth. In come cases the mother is unable to deliver the
baby normally then the expert doctor performs the caesarean section surgically.

Birth is a process by which the baby makes a transition from the

internal environment of the mother's uterus to the world outside.
Stage1-Dilation: The first stage of labour is the longest, lasting
on average of 12 hours. Generally labour is longest and most
difficult for a woman's first delivery. In preparation for birth, changes begin to occur in the mouth of
the womb i.e. cervix at the beginning of the ninth month of pregnancy. The. cervix
becomes softer, and starts opening up. Furthermore the head keeps moving downwards reducing the
height of the uterus. The
mother can easily feel this progress. The labour starts generally at weeks when the baby is low down in
the pelvis and the cervix is open to about 2.5cms. The commonest sign of impending labour is termed
as 'show' ie. the discharge of thick white mucous like fluid with some bleeding in most women.
However, mild
contractions or pains may be the first indication in some of them.
The pains usually begin from the back and come into the front abdomen lasting only for a few seconds.
These irregular pains gradually start occurring at shorter and regular intervals . Sometimes the water
bag or amniotic sac bursts first and clear
water like fluid gushes out.

A woman having her first baby must go to the hospital when the
pains start occurring after every twenty minutes and each pain
lasts for thirty seconds or more. A woman having her second or
54
third baby needs to go to the hospital a little early, as the labour is likely to shorter. In case the water,
bag bursts, the lady must go to the hospital immediately even if there is no pain.

Stage 2- Delivery: Once the contractions have set in, the dilation
of the cervix continues. This stage lasts no more than an hour
and often ends in a few minutes. When the pains occur every
three to four minutes the cervix is dilated up to 5.to6.cms. The complete opening measures 9.5 cm and
the baby. comes out through this opening. The back of the head appears first, then the face and then the
chin. When the head has come out, the face of the baby turns either towards the left or right thigh of
the mother. The shoulders then emerge one after the other and finally the rest of the baby slips out.

All this time, when the baby is coming out, the mother has to keep her legs relaxed and stretched apart.
The mother also has
to play a vital role in expelling the baby out. Her voluntary muscles Come into force and she has to
make expulsive efforts similar to passing of bowels to help the baby come out. It is helpful if she takes
deep breaths and then makes expulsive efforts using her abdominal muscles. An important point to
remember is that she must make these efforts while a contraction is taking place and not when the
uterus is still.

Stage 3- After birth: In this stage the placenta and membranes are expelled, This process usually takes
less five minutes. The physician examines the afterbirth careful
ensure that all of it has been expelled. If it is incomplete, surgery
procedure (D&C-scraping of the uterus) may be perform remove remaining portion.
The presence of a trained person during the birth process
important whether the delivery is conducted at home or in hospital. The health of the mother and the
baby depends on the delivery is conducted. If, for example, the umbilical cord
cut with unclean and unsterilized instruments, the child may
tetanus and die.

Types of Birth
Most of the babies are born through the natural or spontaneous
process. But some of them have to be delivered by the use of surgical
instruments. In general there are four types of birth-natural spontaneous, instrument, breech and
caesarean section.
Natural birth: - In this type of birth, the head appears first. Afi the head, the shoulders emerge one after
the other as the baby rotates in the birth canal, then the arms come one at time finally the legs. In
contrast to this if the buttocks of the chi appear first followed by legs, the arms and finally the head it
called as breech birth,. Instruments are generally used to a breech birth, as there is a risk of being
damaged during the birth
process.
2.Aided Instrument birth: In this case, the birth has to be side by the use of surgical instruments. This
may happen if the size of the foetus is too large to emerge from the birth canal spontaneously. The
position of the foetus in the uterus may also sometimes necessitate the use of instruments, which are
generally forceps and vacuum extractor.
3. Caesarean section: A slit is made on the abdomen of the mother to perform a caesarean section to
deliver the baby. There are many reasons for which the mother has to be operated and the baby
delivered through caesarean section. Some of the reasons are placenta being situated too low and
covering the mouth the uterus, the size of the foetus being too large to emerge spontaneously through
the birth canal, prolonged labour leading to an exhaustion of expulsive forces and labour coming to a
stand still, foetal distress due to prolonged labour, foetus being strangled by its own cord or whenever
there is risk to life of mother or foetus

Hazards During Prenatal Development

Most prenatal development occurs normally, following the established patterns with
little variation. However, there are a number of things that can go wrong during this
time, which are usually caused by genetics or environmental problems.
i) Psychological Hazards: Psychological hazards are serious because their effects
tend to be persistent and as a result influence development after birth as well as
before birth. These are in the form of three hazards;
 Traditional beliefs about parental influences: Traditional beliefs about parental
influences are regarded as hazardous not because of their effects on the
developing child during prenatal period but because of their effects on attitudes
and treatment children receive during the early formative years of their life
from significant people who hold these beliefs.
 Maternal Stress: Stress a persistent form of heightened emotionality involving
such unpleasant emotions as fear, anger, or grief may come from many causes.
It may be the result of not wanting the child-to-be, feeling of inadequacy, or
fear of having a defective child. This stress is hazardous as it upsets the normal
functioning of maternal endocrine system.
 unfavourable attitude on the part of significant people: Unfavourable attitude
held by relatives, siblings, neighbours and friends but most importantly parental
attitude does affect development. These attitudes like wanting the child of a
particular sex, negative attitude towards unwed mother or divorced mother
affect pre as well as postnatal development.
ii) Physical Hazards
56
Period of the Zygote
 Starvation: The zygote will die of starvation if it has too little yolk to keep it alive
until it can lodge itself in the uterine wall or if it remains too long in the tube.
 Lack of Uterine Preparation: Implantation cannot occur if, as a result of glandular
imbalance, the uterine walls are not prepared in time to receive the zygote.
 Implantation in the wrong place: If the zygote becomes attached to a small fibroid
tissue in the uterine wall or to the wall of the Fallopian tube, it can’t get
nourishment and will die.
iii)Period of the Embryo
 Miscarriages: Falls, emotional shocks, malnutrition, glandular disturbances,
vitamin deficiency, and serious diseases such as pneumonia and diabetes can cause
the embryo to become dislodged from its place in the uterine wall, resulting in a
miscarriage. Miscarriages that are due to un-favourable conditions
in prenatal environment are likely to occur between the tenth and eleventh weeks
after conception.
 Development Irregularities: Maternal malnutrition, vitamin and glandular
deficiencies, excessive use of drugs, alcohol, tobacco and diseases like diabetes and
German measles, interfere with normal development, especially that of the
embryonic brain.
iv)Period of the Fetus
 Miscarriages: Miscarriages are always possible up to the fifth month of pregnancy,
the most vulnerable time when the woman’s menstrual period would normally
occur.
 Prematurity:Fetuses who weigh less than 2 pounds 3 ounces have less chances of
surviving than heavier fetuses and a greater chance of developing malformations.
 Complications of delivery: Maternal stress affects uterine contractions and is likely
to lead to complications during birth.
 Developmental Irregularities: Any of the unfavourable environmental conditions
present during the period of the embryo will also affect the development of fetal
features and retard the whole pattern of fetal development.
v)Teratological Hazards
 Teratogen agent that causes birth defect.
 Maternal Factors emanating from mother are: age, nutrition, emotional state and
stress.
 Toxoplasmosis disease caused from parasite ingested from eating raw meat, or
touching cat feces.
 Ectopic Pregnancy presence of developing embryo or fetus outside normal location
in uterus.
 Fetal Alcohol Syndrome cluster of abnormalities that appears in offspring of
mothers who drink alcohol heavily during pregnancy.
 Paternal Factors emanating from father are: exposure to lead, radiation, pesticides,
and petrochemicals.
 Also, fathers who have a diet low in vitamin C, often produce offspring with higher
risks of birth defects and cancer.
vi)Environmental Hazards
 Pollutants, toxic wastes, chemicals & radiation can cause birth defects or adversely
affect developing fetus.
 Recent research has shown that prolonged exposure by mothers to heat in saunas or
hot tubs also endanger fetus.
 Fetal Surgery and Therapy is a recent practice in which surgical treatment is used to
correct possible defects before permanent damage results after birth.
The prenatal period is a crucial period of development of our lives. It is the formative
period for all our body organs and plays a role in establishing their functional capacity.
The potential exists for severe disruption to the normal developmental process from
environmental agents. However for the vast majority of pregnancies the environment
exerts a positive effect, shaping the individual’s development. The fetus is an active
participant in its own development. Its behaviour is important for progressing normal
development within the womb and for its life in the postnatal world. It is the foundation
on which all future development after birth is built.
ANTENATAL CARE The word 'antenatal care' means the care of woman during
pregnancy. Such care includes both physical and psychological care. The primary aim
of antenatal care is to achieve a healthy mother and a healthy baby at the end of
pregnancy. The objectives of antenatal care are:
(i) To promote, protect and maintain the health of the mother during pregnancy.
(ii) To foresee complications and prevent them.
(iii) To detect "high risk" cases and give them special attention.
(iv) To remove anxiety associated with delivery.
(v) To reduce maternal and infant mortality and morbidity.
(vi) To teach mother the elements of childcare, nutrition, personal hygiene and
environmental sanitation.
(vii) To sensitize mother to the need of family planning.
In older days child was studied as a child and not as an individual. Events prior to birth
were regarded unimportant but now research have proved that the environment in which
the child grows up has a tremendous influence on the development of child.

58
An Overview of Prenatal Development
One of the most important points about the child's prenatal development is how
remarkably regular and predictable it is. If the embryo has survived the early, risky
period (roughly the first 12 weeks), development usually proceeds smoothly, with the
various changes occurring in what is apparently a fixed order, at fixed time intervals,
following a clear maturational ground plan.
This sequence of development is not immune to modification or outside influence, as
you'll soon see in detail. Indeed, as psychologists and biologists have looked more
carefully at various kinds of teratogens, it has become clear that the sequence is more
vulnerable than had earlier appeared. But before I begin talking about the various things
that can go wrong, I want to make sure to state clearly that the maturational system is
really quite robust. Normal prenatal development requires an adequate environment, but
"adequate" seems to cover a fairly broad range.
Most children are quite normal. The list of things that can go wrong is long, and getting
longer as our knowledge expands. Yet many of these possibilities are quite rare. many
are partially or wholly preventable, and many need not have permanent consequences
for the child.

POSTNATAL PERIOD

Postnatal (Latin for ‘after birth’, from post meaning “after” and natalis meaning “of
birth”) is the period beginning immediately after the birth of a child and extending for
about six weeks. Another term would be postpartum period, as it refers to the mother
(whereas postnatal refers to the infant).
Birth is not the beginning of life. Instead, it is merely an interruption in the development
pattern that began at the time of conception. It is the time when the individual must
make a transition from the internal environment of the mother’s uterus to the world
outside the mother’s body. The time when the transition is being made, the period of
Partunate begins. This period covers the first 15 or 30 minutes after birth. With the
cutting of umbilical cord, the infant becomes a separate, distinct and independent
individual. When adjustments to the postnatal environment are being made, no marked
changes in development occur.

Adjustments to Postnatal Period

Because of the vast difference between the internal and external environments, infants
must make radical and rapid adjustments. If they don’t make them, their lives will be
threatened. There are four major adjustments every infant must make:
1) Adjustment to the temperature change: In the sac in the mother’s uterus, the
temperature is constantly around 100F. In the postnatal environment, it will be
between 68 and 70F and will vary.
2) Adjustment to breathing: Before birth, oxygen comes from the placenta through
the umbilical cord. After birth when this cord is cut, the infant must inhale and
exhale air. The birth cry normally comes when breathing begins and serves to
inflate the lungs. Initially breathing is irregular and imperfect. The infant yawns,
gasps, sneeze and coughs to regulate breathing process.
3) Adjustment to taking nourishment: Since the reflex activities of sucking and
swallowing are imperfectly developed, the infant is frequently unable to get the
nourishment and thus loses weight. This is in total contrast to prenatal period where
the fetus received constant nourishment through umbilical cord.
4) Adjustment to elimination: Within a few minutes after birth, the excretory system
begins to function, eliminating waste products from the body which formerly were
eliminated through the umbilical cord and the maternal placenta.

How Birth Affects Postnatal Development

Birth will affect the postnatal development of one individual differently than of another
individual. The following conditions are responsible for the effect of birth on postnatal
development:
1) Type of birth: Generally there are five different types of birth:
 Natural or spontaneous birth: It occurs without any external support and with a
minimum of or no medication of the mother. The position of fetus and the size
of fetus make it possible for the fetus to emerge head first.
 Instrument birth: If the fetus is too large to emerge from the mother’s body
spontaneously or its positioning the uterus is such that it makes normal birth
impossible, then surgical instruments must be used to aid ion delivery.
 Breech birth: The fetus buttocks appear first, followed by legs and arms and
finally the head. If the position cannot be changed before the birth begins
instruments must be used to aid in delivery.
 Transverse-Presentation birth: The fetus lies crosswise in the uterus. If this
position can not be changed instruments must be used to aid in delivery.
 Caesarean-Section birth: When the fetal body becomes too large to pass
through the birth canal without a prolonged and a difficult labor, even when
instruments are used, the fetus is delivered surgically by making a slit in the
maternal abdominal wall.
2) Medication of the mother: The more the medication before and during childbirth,
the longer and more difficult the infant’s adjustment to postnatal life. The effects
vary according to the type, amount and the timing of the medication. It affects
breast feeding and the infants loose more weight.
60
3) Prenatal environment: Many childbirth complications have been traced to prenatal
environment. The unfavorable prenatal conditions usually persist after birth and
manifest in various adjustment difficulties such as feeding problems,
gastrointestinal dysfunction, sleep problems, hyperactivity and irritability.
4) Length of gestation period: The average length of gestation period is 38 weeks or
266 days, very few infants arrive in this period. Those who arrive late are called
“Postmatures” and those who arrive early are called “Prematures”. Premature
infants usually experience difficulty in adjusting to their postnatal life whereas
postmature infants adjust more quickly and successfully to the postnatal life, even
better than full term infants.
5) Postnatal care: The type of care received in the early days following birth affects
postnatal development. Nutrition, breast feeding, healthy and safe environment,
love and affection do affect the infant.
6) Attitude of the parents: Whether the child is being received positively or
negatively, affects postnatal development of infant. If the parents welcome the child
unconditionally then the child develops into a physically and psychologically
healthy individual.
Some psychologists have considered all stages of life in the postnatal period, though
dictionary meaning is restricted to approximately one month after birth. They have
termed this one month period as neonatal period.

CHARACTERISTICS OF THE NEW BORN

A new born baby is tiny, weighing on an average 2500 grams and is about 21 inches
long. The head of the new born is about one-fourth of rest of the body: Her/his body is
covered with soft-downy hair. The body is also coated with waxy substance at the time
of birth.

Soon after the birth this coating dries and begins to peel off. The skin is red and
wrinkled.

When born, he looks helpless. When observed carefully it could be found that even at
the time of birth the child has certain capabilities.

The child displays reflexes in response to some stimulus. The child is also born with the
capacity to see. He looks towards light, and some can even follow a slow moving light.
Babies can also hear.

They respond to sound by turning their head towards the direction from which sound is
coming. The new born is sensitive to touch and smell, and within a few days after birth,
displays understanding of mother's touch her smell and begins to recognize her voice.
The child is born with all the five senses, viz. vision, hearing, smell, taste and touch.
These senses help him to gain experiences from the surroundings and make see of the
world around.

coordinated patterns of behaviour or automatic physical movements in response to a

particular event of stimulus. These help the baby's body to function. All the reflexes
help the neonate to adjust to the new environment and to survive e.g. rooting reflex
allows the newborn to reach for the breast or bottle while sucking reflex is associated
with feeding and is important for baby's health. Reflexes, if not observed at the time of
birth, could indicate immaturity of the central nervous system of the new born. Moro or
the startle reflex is very weak for infants with hearing impairment. Absent or weak
Moro reflex could be an early sign of hearing impairment. Some reflexes can be seen
only for a short time (rooting, grasp and startle) while others remain throughout the
lifespan such as automatic blinking of our eyes when some thing comes close to eyes or
automatic moving away of ones hand when it touches a hot object.

Physical Development

Infants differ greatly in appearance and physiological functions at birth and in their
early adjustments after birth.

Size

At birth, the average infant weighs 7½ pounds and measures 19½ inches in length.
Weight in relation to height is less at birth, on the average, in the more active fetuses
than in those who have been less active during the latter part of the fetal period. Boys,
on the whole, are slightly longer and heavier than girls.

There are marked individual differences, however, in infants of both sexes.

Infantile Features The muscles of the new-born infant are soft, small, and
uncontrolled. At the time of birth, less development has taken place in the muscles of
the neck and legs than in those of the hands and arms. The bones, like the muscles, are
soft and flexible because they are composed chiefly of cartilage or gristle. Because of
their softness, they can readily be misshapen. The skin is soft and often blotchy. The
flesh is firm and elastic. The skin of white infants becomes lighter as they grow older
while that of non-whites becomes darker (77).

Frequently, soft downy hair is found on the head and back, though the latter. soon
disappears.

The eyes of white new-borns are usually a bluish gray, though they gradually change to
whatever their permanent color will be. Infants with dark skin have dark brown eyes but
they also change, becoming darker in time. Natal teeth occur approximately once in
every 2,000 births. They are the "baby" type and are usually lower central incisors.

62
Physical Proportions The newborn is not a miniature adult. This is illustrated in Figure
3-3. The head is approximately one-fourth of the body length; the adult head, by
comparison, is approximately one-seventh of the total body length. The cranial region,
the area over the eyes, is proportionally much larger than the rest of the head, while the
chin is proportionally much too small. By contrast, the eyes are almost mature in size.
The nose is very small and almost flat on the face, while the tiny mouth may look like a
slit if the lips are narrow.

The neck is so short that it is almost invisible, and the skin covering it lies in thick folds
or creases.

In the trunk, the shoulders are narrow, while the abdomen is large and bulging.
Proportionally, the arms and legs of the infant are much too short for the head and trunk.
The hands and feet are miniature.

Physiological Functions

Because of the undeveloped state of the autonomic nervous system at birth, the infant is
unable to maintain homeostasis, which is one of the causes of the high mortality rate at
this time.

With the birth cry, the lungs are inflated and respiration begins. The respiration rate at
first ranges from forty to forty-five breathing movements per minute. By the end of the
first week of life, it normally drops to approximately thirty-five per minute and is more
stable than it was at first.

Neonatal heartbeat is more rapid than that of the adult because the infant's heart is
small compared with the arteries. When body movements are restricted by means of
swaddling the infant's body, there is an increase in stability of the heartbeat. As a result,
the infant is quieter, sleeps more, and has a lower heart rate. Even in a healthy infant,
the temperature is higher and more variable than in the adult.

Reflex sucking movements occur when the infant is hungry or when the lips are
touched. There is an increase in the rate of sucking and in the amount of nutrients
consumed with each passing day, partly because of maturation and partly because of
learning.

The hunger rhythm does not develop until several weeks after birth. The hunger
demands of the newborn are therefore irregular, not only in regard to intervals between
feedings but also in regard to amounts. Because the hunger contractions of the infant are
more vigorous than those of the adult, the infant experiences real pain when hungry.

Elimination of waste products begins a few hours after birth. Many voidings occur
during periods of wakefulness and when the infant is quiet, usually within an hour after
feeding. Defecations likewise occur when the infant is awake and quiet, shortly after
feeding.
in . In no physiological function is lack of homeostasis more apparent than in sleep.
Neonatal sleep is broken by short waking periods which occur every two or three hours,
with fewer and shorter waking periods during the night than during the day.

Throughout the neonatal period, there is a general increase in bodily movements during
sleep as well as during the time the infant is awake.

There are marked variations in infant posture during sleep. However, the characteristic
posture, when prone, is similar to that of the fetus during intrauterine life. By the end of
the first month of life, this posture is generally outgrown, owing to the tonus of the
baby's musculature.

During the postnatal development stage of the first three months, infants undergo
significant growth and development in various aspects

Physical growth: Infants experience rapid physical growth during this period. On
average, babies may gain about 1.5 to 2 pounds (0.7 to 0.9 kg) per month and grow
approximately 1 inch (2.5 cm) in length per month.

Motor skills: Infants gradually develop their motor skills during the first three months.
They start to gain more control over their head and neck, becoming capable of lifting
their head momentarily during tummy time and tracking objects with their eyes. By the
end of the third month, some infants may begin to roll over from their tummy to their
back.

Reflexes: Newborn reflexes, such as the Moro reflex (startle reflex) and the rooting
reflex, begin to diminish during the first few months. These reflexes are gradually
replaced by more intentional and controlled movements.

Sensory development: Infants' sensory abilities continue to develop. They become

more responsive to visual stimuli, focusing their gaze on faces and objects, and may
start to track moving objects with their eyes. They also begin to recognize familiar
voices and show signs of social responsiveness, such as smiling and cooing.

Sleeping patterns: Infants' sleep patterns start to become more regular. They typically
sleep for shorter periods during the day and longer stretches at night, although
individual variations are common. By three months, some babies may begin to establish
a more consistent sleep-wake cycle.

64
Feeding: Infants continue to grow and develop through proper nutrition, either through
breastfeeding or formula feeding. In the first three months, babies generally feed every
2 to 4 hours, with an average of 8 to 12 feedings per day.

Cognitive development: While newborns primarily respond to sensory stimuli, infants

between one to three months start to exhibit more intentional behaviors. They may
focus on and follow objects, engage in social interactions, and display early signs of
curiosity.

Communication and language development: Infants begin to communicate and

express themselves through various sounds and facial expressions. They start cooing,
making gurgling noises, and may engage in "conversation" by imitating or responding
to adult vocalizations.

Emotional development: During the first three months, infants form emotional bonds
with their primary caregivers, typically their parents. They develop a sense of trust and
security, seeking comfort and reassurance from their caregivers.

Tummy time: Tummy time, which involves placing the baby on their stomach while
awake and supervised, helps strengthen their neck and shoulder muscles and promotes
the development of motor skills. Gradually increasing tummy time duration is
encouraged during this period.

User

more
ChatGPT

Certainly! Here are some additional notes on postnatal development in infants during
the first three months:

Social development: Infants begin to show increased social awareness and

responsiveness. They may start to smile in response to familiar faces and voices, and
may show signs of enjoyment during social interactions.

Grasping and reaching: Infants develop their hand-eye coordination and begin to
explore objects by reaching out and grasping them. They may exhibit a palmar grasp,
where they tightly grip objects placed in their palm.

Head control: By the end of the third month, many infants develop better head control
and can hold their head steady for short periods when supported in an upright position.

Visual tracking: Infants' ability to track moving objects with their eyes improves during
this period. They can follow objects or people moving within their line of sight,
demonstrating smoother and more coordinated eye movements.

Sensory exploration: Infants become more engaged in sensory exploration, using their
senses to gather information about their environment. They may show interest in
visually stimulating objects, touch and explore different textures, and respond to sounds
and voices.

Vocalizations: Infants continue to make cooing and gurgling sounds, experimenting with
their vocal abilities. They may begin to imitate certain sounds or engage in back-and-
forth "conversations" with caregivers, using babbling sounds.

Facial expressions: Infants develop a wider range of facial expressions, including

smiles, frowns, and different mouth movements. They may also show expressions of
surprise, interest, and displeasure.

66
Sensitivity to routines: Infants may start to develop a sense of routine and show signs of
anticipation or recognition of familiar activities, such as feeding or bedtime routines.

Increased alertness: Infants gradually spend more time awake and alert, with longer
periods of engagement and interaction with their surroundings.

Sensitive periods: The first three months are considered a sensitive period for bonding
and attachment between the infant and their primary caregivers. Responsive and
nurturing caregiving during this time supports the development of a secure attachment.

Stages of Postnatal Development

Neonatal period
 birth to end of 4th week
 newborn begins to carry on respiration, obtain nutrients, digest nutrients, excrete
wastes, regulate body temperature, and make cardiovascular adjustments
Infancy
 end of 4th week to one year
 growth rate is high
 teeth begin to erupt
 muscular and nervous systems mature
 communication begins
Childhood
Adolescence
Adulthood
Senescence

Elizabeth B. Hurlock(1980) Developmental Psychology. A Life-Span Approach,

Prentice Hall, New York.
John W. Santrock :Life-Span Development. Holt Rinehart, New York.