Summary

4.1 The Stages of Childbirth

4.1 Describe the three stages of childbirth, the baby’s adaptation to labor and delivery, and the newborn baby’s
appearance.

 In the first stage, dilation and effacement of the cervix occur as uterine
contractions increase in strength and frequency. This stage culminates
in transition, a brief period of peak contractions in which the cervix opens
completely. In the second stage, the mother feels an urge to push the baby
through the birth canal, and the baby is born. In the final stage, the placenta is
delivered.
 During labor, infants produce high levels of stress hormones, which help them
withstand oxygen deprivation, clear their lungs for breathing, and arouse them
into alertness.
 Newborns may be odd-looking, but their facial features make adults feel like
cuddling them.
 The Apgar Scale assesses the baby’s physical condition at birth.
4.2 Approaches to Childbirth
4.2 Describe natural childbirth and home delivery, noting benefits and concerns associated with each.

 In natural, or prepared, childbirth, the expectant mother and a companion

typically attend classes where they learn about labor and delivery, master
relaxation and breathing techniques to counteract pain, and prepare for
coaching during childbirth. Social support from a doula reduces the need for
instrument-assisted births and pain medication and is associated with higher
Apgar scores.
 An upright position and water birth are increasingly popular alternatives that
ease labor and delivery for both mother and baby, compared to the traditional
lying on the back, feet in stirrups hospital position.
 Home birth is safe for healthy mothers assisted by a well-trained doctor or
midwife, but mothers at risk for any complication are safer giving birth in a
hospital.
4.3 Medical Interventions
4.3 List common medical interventions during childbirth, circumstances that justify their use, and any dangers
associated with each.

 Fetal monitors help save the lives of many babies at risk for anoxia due to
pregnancy complications. Used routinely, however, they may identify infants as
in danger who are not, contributing to an increase in instrument and cesarean
deliveries.
 Use of analgesics and anesthetics to control pain, though sometimes necessary,
can prolong labor and compromise newborn adjustment.
 Although appropriate when the mother’s pushing is insufficient, instrument
delivery can cause serious complications and should be avoided if possible.
 Cesarean delivery is warranted for medical emergencies and in some cases
of breech position. However, many unnecessary cesareans are performed.

4.4 Birth Complications

4.4a Describe risks associated with oxygen deprivation and with preterm and low-birth-weight infants, along with
effective interventions.

 Inadequate oxygen supply during labor and delivery can damage the brain,
resulting in persisting motor and cognitive deficits that vary in severity with the
extent of anoxia. Hypothermia treatment substantially reduces brain damage
due to anoxia.
 Low birth weight, most common in infants born to poverty-stricken women, is
a major cause of neonatal and infant mortality and developmental problems.
 Compared with preterm infants, whose weight is appropriate for time spent in
the uterus, small-for-date infants usually have longer-lasting difficulties.
However, even minimally preterm babies experience greater rates of illness and
persisting, mild intellectual delays.
 Some interventions for preterm infants provide special stimulation in the
intensive care nursery. Others teach parents how to care for and interact with
their babies. Preterm infants in stressed, low-income households need long-
 term, intensive intervention. Skin-to-skin “kangaroo care” promotes survival
and diverse aspects of development in preterm infants.
 Countries that outrank the United States in infant survival promote prenatal
health and effective parenting through government-sponsored high-quality
health care and generous, paid employment leave.
4.4b Describe factors that promote resilience in infants who survive a traumatic birth.

 When infants experience birth trauma, a supportive family environment or

relationships with other caring adults can help restore their growth. Even
infants with fairly serious birth complications can recover with the help of
positive life events.

4.5 The Newborn Baby’s Capacities

4.5a Describe the newborn baby’s reflexes and states of arousal, including sleep characteristics and ways to
soothe a crying baby.

 Reflexes are the newborn baby’s most obvious organized patterns of behavior.
Some have survival value, others help parents and infants establish gratifying
interaction, and still others provide the foundation for voluntary motor skills.
 Although newborns move in and out of five states of arousal, they spend most
of their time asleep. Sleep includes at least two states: rapid-eye-movement
(REM) sleep and non-rapid-eye-movement (NREM) sleep. Newborns spend
about 50 percent of their sleep time in REM sleep, far more than they ever will
again. REM sleep provides young infants with stimulation essential for central
nervous system development. Sleep contributes to babies’ learning and
memory.
 Disturbed REM–NREM cycles are a sign of central nervous system
abnormalities, which may lead to sudden infant death syndrome (SIDS).
 A crying baby triggers strong feelings of discomfort in nearby adults. Once
feeding and diaper changing have been tried, lifting the baby to the shoulder
and rocking or walking is a highly effective soothing technique. Extensive
parent–infant physical contact substantially reduces crying in the early months.
Support programs can help parents acquire techniques that reduce excessive
infant crying.
4.5b Describe the newborn baby’s sensory capacities.
  The senses of touch, taste, smell, and sound are well-developed at birth.
Newborns use touch to investigate their world, are highly sensitive to pain,
prefer sweet tastes and smells, and orient toward the odor of their own mother’s
lactating breast and toward human milk rather than formula milk. Attraction to
certain flavors, developed through prenatal exposure to a mother’s diet or
through breast milk, can, in some instances have long-term consequences for
odor and taste preferences.
 Newborns can distinguish a variety of sound patterns as well as nearly all
speech sounds. They are especially responsive to human speech, high-pitched
expressive voices, their own mother’s voice, and speech in their native
language.
 Vision is the least developed of the newborn’s senses. At birth, focusing ability
and visual acuity are limited. Nevertheless, newborns can detect human faces
and prefer their mother’s familiar face to the face of a stranger. In exploring the
visual field, they are attracted to bright objects but tend to limit their looking to
single features. Newborn babies have difficulty discriminating colors.
4.5c Explain the usefulness of neonatal behavioral assessment.

 The most widely used instrument for assessing the behavior of newborn infants,
Brazelton’s Neonatal Behavioral Assessment Scale (NBAS), has helped
researchers understand individual and cultural differences in newborn behavior.
 Changes in NBAS scores over the first week or two of life provide the best
estimate of the baby’s ability to recover from the stress of birth. Sometimes the
NBAS is used to teach parents about their baby’s capacities.

4.6 The Transition to Parenthood

4.6a Discuss the influence of birth-related hormonal changes and parent–infant contact on emergence of
parental affection and concern for the infant.

 Near birth, mothers—as well as fathers in a warm couple relationship—

experience hormonal changes associated with sensitivity and responsiveness to
the baby. Although human parents do not require close physical contact with
the infant immediately after birth for bonding to occur, hospital practices that
promote parent–infant closeness, such as rooming in, may help parents build a
good relationship with their newborn.
4.6b Describe changes in the family after the birth of a baby, along with interventions that foster the transition to
parenthood.

 In response to the demands of new parenthood, the gender roles of parents

usually become more traditional. Parents in gratifying marriages who continue
 to support each other’s needs generally adapt well. But in dual-earner
marriages, a large difference between a couple’s caregiving responsibilities can
threaten marital satisfaction, especially for women, and negatively affect
parent–infant interaction. Favorable adjustment to a second birth typically
requires that fathers take an even more active role in parenting.

 Early therapeutic intervention can prevent parental depression from interfering

with effective caregiving and the parent–child relationship.
 Planned births and adoptions by never-married, well-educated women in their
thirties and forties have increased dramatically. These mothers typically adapt
 easily to parenthood. Most nonmarital births are unplanned and to poverty-
stricken young women experiencing a stressful transition to parenthood.
 When parents are at low risk for problems, counselor-led interventions that
focus on strengthening the couple’s relationship and their coparenting skills can
ease the transition to parenthood. High-risk parents struggling with poverty or
the birth of a baby with disabilities are more likely to benefit from intensive
home interventions focusing on enhancing social support and parenting.