Childhood and Adolescence: Voyages in Development, 7e: Chapter 4: Birth and The

Childhood and
Adolescence: Voyages
in Development,
7e
Chapter 4: Birth and the
Newborn Baby
©2022 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1
Learning Objectives
By the end of this chapter, you will be able to:

4-1 Describe the three stages of childbirth.
4-2 Discuss methods of childbirth, focusing on ways of alleviating the discomfort
of childbirth and on cesarean delivery (C-sections).
4-3 Discuss birth problems, including the effects of oxygen deprivation and on
preterm delivery and low-birth-weight babies.
4-4 Discuss issues that occur during the postpartum period, including possible
psychological challenges experienced by mothers, and parental–infant bonding.
4-5 Describe the characteristics of neonates.
4-6 Discuss sudden unexpected infant death and sudden infant death syndrome.
4.1 Stages of Childbirth
Events in the Last Month of Pregnancy (1 of 2)
• Dropping or lightening
− Head of fetus settles in pelvis
• Braxton-Hicks contractions or false labor contractions
• Blood may appear in vaginal secretions
• Mucous plug is dislodged
• “Water breaks” (discharge of amniotic fluid)
Events in the Last Month of Pregnancy (2 of 2)
• Indigestion, diarrhea, backache, and abdominal cramps are common

signs labor is beginning
• Fetal hormones stimulate placenta and uterus to secrete
prostaglandins
− Prostaglandins cause cramping and labor contractions
• Pituitary gland releases the hormone oxytocin
− Oxytocin stimulates contractions to expel the baby
What Happens During the First Stage of
Childbirth? (1 of 2)
• Regular uterine contractions efface and dilate the cervix
• First stage is longest
− May last from a few hours to more than a day
• If mother is to be “prepped,” it is done now
− Pubic hair shaved
− Enema given
− Many women find this degrading and prefer not to be prepped
What Happens During the First Stage of
• Fetal monitoring may be used
− Electronic device measures fetal heart rate and mother’s contractions
• Forceps or vacuum extraction tube may be used to speed up delivery if
there is fetal distress
• Transition (lasts about 30 minutes or less)
− Cervix almost fully dilated
− Head of fetus begins to move into birth canal (vagina)
− Frequent, strong contractions
What Happens During the Second Stage of
• Baby appears at opening of birth canal
• Briefer than first stage; may last minutes or a few hours
• Culminates in birth of baby
• “Crowning” = baby’s head begins to emerge
• Episiotomy may be performed to prevent random anal tearing
• Baby’s head and face initially may appear misshapen
• Baby is not held upside down and slapped as in old movies
What Happens During the Second Stage of
• Mucus is suctioned from baby’s mouth as soon as head emerges
− To clear any obstructions from airway; may be repeated
• When baby is breathing on its own, umbilical cord clamped and severed
− Stump will dry up and fall off in about 10 days
• Baby is often whisked away by nurse for various procedures
− Footprints the baby
− Gives baby an ID bracelet
− Puts antibiotic ointment/drops in baby’s eyes
− Gives baby vitamin K injection to enable blood clotting
Umbilical Cord Clamped and Severed
What Happens During the Third Stage of
Childbirth?
• Also called the placental stage
• Can last a few minutes to an hour or more
• Placenta separates from uterine wall
− Expelled through birth canal with fetal membranes
− Bleeding is normal
− Uterus begins process of shrinking
• Obstetrician sews up episiotomy if one was performed
The Stages of Childbirth
4.2 Methods of Childbirth
How Is Anesthesia Used in Childbirth?
• General anesthesia
− Puts mother to sleep
− Can have negative effects on infant
 Abnormal patterns of sleep and wakefulness
 Decreased attention, social responsiveness shortly after birth
 Some variability due to physician’s administration, not drugs
• Regional or local anesthetics (pudendal, epidural, spinal)
− Deaden pain without putting mother to sleep
− Minor, short-lived depressive effects on neonates
− In natural childbirth, no anesthesia is used
Epidural Anesthesia Kit
What About Hypnosis and Biofeedback?
• “HypnoBirthing”
− Focuses on relaxing scenes
− Decreases muscle tension
− Does not fully eliminate pain, but puts mother in charge and gives her something
to focus on during delivery
• Biofeedback
− Provides continuous information on bodily functions
− Helps in regulating heart rate and reducing muscle tension
− Studies suggest positive effects on coping with pain of labor
What Is Prepared Childbirth?
• Lamaze method
− Taught in classes with a “coach,” most often mother’s partner
− Teaches breathing and relaxation exercises
− Enables mother to minimize tension, conserve energy, feel less anxiety
− Puts mother in control rather than health professionals
− Mother receives education on childbirth
 Coach/partner integrated into process
• More social support
• Can decrease discomfort of childbirth
• Women with coaches/doulas seem to have shorter labors
• Many health insurance plans now offer some payment for doulas
Why Are Cesarean Sections Used So Widely?
What Are Their Pluses and Minuses?
• Cesarean section or C-section is surrounded by controversy
− Baby is delivered by abdominal surgery
− Physicians prefer C-section when they believe normal delivery may
threaten mother or child or be more difficult than desired
 Maternal small pelvis
 Maternal weakness or fatigue (e.g., by prolonged labor)
 Baby too large or in apparent distress
 To prevent transmission of genital herpes and HIV
 If baby is facing in the wrong direction, to reduce risk of hypoxia
• Some mothers want C-sections to avoid labor pain or to schedule
delivery
C-Sections and Vaginal Births After C-Section
Figure 4.4: Percentage of American Women Having C-Sections and Vaginal Births after C-Section.
About one-third of women (32%) have had C-sections in recent years. Despite the view that women who have had C-
sections will always have them to prevent rupture of the uterine lining during delivery, we see that some 12–13% of women
who had previous C-sections are having vaginal births.
Is Home Birth Too Risky, or Is It Something to
Consider?
• Most women in the United States give birth in hospitals
• Home delivery can be reasonably safe:
− For healthy women
− If believed to have little risk of complications
 Especially if they have given birth before
− Certified nurse midwife can assess before assisting with home birth
• Recaptures warm family experience of childbirth
• Keeps mother primary rather than medical professionals
• Lowers costs of maternity care for uncomplicated pregnancies and deliveries
4.3 Birth Problems
What Are the Effects of Oxygen Deprivation at
Birth? (1 of 2)
• Anoxia (no oxygen), hypoxia (not enough oxygen) prenatally
− Can impair development of central nervous system
 Cognitive and motor problems
 Cerebral palsy
 Psychological disorders
• Prolonged cutoff of oxygen during delivery
− Early-onset schizophrenia
− Cerebral palsy
− Can be lethal
What Are the Effects of Oxygen Deprivation at
Birth? (2 of 2)
• Causes of oxygen deprivation
− Maternal disorders, such as diabetes
− Immaturity of baby’s respiratory system
− Accidents, some causing prolonged constriction of umbilical cord
 Prolonged constriction more likely in breech presentation (bottom-first)
 Fetal monitoring can help detect anoxia before it causes damage
 C-section can be performed if fetus seems to be in distress
What Are the Risks in Being Born Preterm or Low
in Birth Weight? (1 of 4)
• Prematurity and low birth weight usually go together
− Fetus makes dramatic weight gains in last weeks of pregnancy
• Premature or preterm = birth at/before 37 weeks
− Normal gestation is 40 weeks
• Low birth weight = less than 5½ pounds (about 2,500 grams)
− Even if born at full term, called small for dates
• Smoking, using drugs, improper nutrition put babies at higher risk of being
small for dates
− Babies tend to remain smaller; show slight learning delays, attention problems
• About 7% of U.S. children are premature
− Among multiple births, risk rises to at least 50%
• Neonates between 3¼ and 5½ pounds are seven times more likely to die than
normal birth weight neonates
• Neonates weighing less than 3½ pounds are nearly 100 times as likely to die
• The lower the birth weight, the poorer the measures of neurological
development and cognitive functioning throughout the school years
• Higher risks for delayed motor development
− In one study, low-birth-weight infants walked later than full-term infants
• Signs of prematurity
− Lanugo (fine, downy hair)
− Vernix (oily white substance on skin)
− Lack fat layer of full-term babies
− If born 6 weeks or more before term:
 Nipples not yet emerged
 Boys’ testicles not descended into scrotum
− Immature muscles
 Weak breathing and sucking reflexes
• Signs of prematurity
− Air sacs in lungs do not yet secrete lubricating surfactants
− Air sacs tend to stick together
 Respiratory distress syndrome
 In about 1 of 7 babies born 1 month early
• More frequent in babies born even earlier
• Causes a large percentage of U.S. neonatal deaths
• When severe: poorer cognitive, language, motor skill development
• More persistent neurological abnormalities in first 2 years
• Prenatal corticosteroid injections can prevent respiratory distress or severe lung
disease
Treatment of Preterm Babies (1 of 2)
• Babies placed in incubators

− Maintain temperature-controlled environment, some protection from disease
• Parents often do not treat preterm neonates as well as full-term neonates
− Less robust, appealing physical appearance
− Higher-pitched, grating cries; more irritable
− Demands of caring for them can be stressful
− Mothers often feel alienation, failure, guilt, low self-esteem
− At home, babies more passive/less sociable, demand less interaction
 Mothers feel overprotective: babies explore less
− Infants fare better with more parental interaction
Treatment of Preterm Babies (2 of 2)
• Intervention programs
− Cuddling, rocking, talking, singing to babies
− Playing recordings of mothers’ voices
− Having mobiles in view
− Live and recorded music
− Massage and “kangaroo care” (skin to skin) with parent
 Decreases stress and pain in preterm infants
• Preterm infants exposed to stimulation:
− Gain weight faster
− Fewer respiratory problems
− Greater motor, intellectual, neurological development
U.S. Infant Mortality Rates by State
Figure 4.5 Infant Mortality Rates by State

Source: National Center for Health Statistics. (2019). Infant mortality rate by state.
https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm.
4.4 The Postpartum Period
Psychological Problems Women Encounter During
the Postpartum Period
• “Baby blues”
− Serious but transient; they generally do not impair functioning
• Postpartum depression (PPD)
− As many as 1 in 7 women
− Major depression with perinatal onset
− Most often begins about a month after delivery; can last weeks, even
months
• Postpartum psychosis
− About 1 in 1,000 new mothers
− May include hallucinations, delusions
− Emergency with high suicide and infanticide rates (about 4% each)
How Critical Is Parental Interaction with Neonates
in the Formation of Bonds of Attachment? (1 of 3)
• Bonding
− Formation of bonds of attachment between parents and children
− Essential to survival and well-being of children
− “Maternal-sensitive” period (Klaus & Kennell, 1978)
 First hours postpartum as special bonding opportunity
• Mothers with extended contact more likely to cuddle, soothe, and interact with
babies
• Controversial due to issues with methodology
• Behavior changes when aware of being observed (Hawthorne effect)
• Solid adoptive relationships without early access
• Parent–child bonding is a complex process
− Parental desire for child
− Parent–child familiarity
− Parental caring
• “Cross-generational transmission of bonding”
− Tharner et al. (2012)
− History of rejection by one’s parents can interfere with bonding with one’s
own children
• Some notes on father–newborn bonding
− Australian study (Fletcher et al., 2008)
 Professionally employed new fathers seek information about father–newborn
bonding
− Swedish study (Premberg et al., 2008)
 Fathers bonded by assigning babies primary importance and spending time
alone with them
 Fathers reported newborns provided feelings of happiness and warmth
− Father–newborn bonding affected by relationship with mother
− Bonding also affected by father’s own psychological well-being
4.5 Characteristics of Neonates
How Do Health Professionals Assess the Health of
Neonates? (1 of 2)
• Apgar scale
− Score of 0–10 based on five signs of health
− Score of 7 or higher = not in danger
− Score below 4 = critical condition
− A = appearance; P = pulse; G = grimace; A = activity level; R = respiratory
effort
• Brazelton Neonatal Behavioral Assessment Scale (NBAS)
− Assesses five areas of behavior in normal infants
 Motor behavior; response to people; response to stress; adaptive behavior;
physiological control
How Do Health Professionals Assess the Health of
Neonates? (2 of 2)
• Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS)
− Brazelton, Lester, and Tronick (2004)—to assess at-risk infants
− Especially for infants exposed to parental substance abuse
− Assesses relative emotional stability/instability; overall irritability; signs of
stress; response to handling; response to soothing; response to auditory
and visual stimulation; ability to self-soothe
− While administering scale, consultant can observe parent–infant
interactions and suggest more effective behaviors
What Are Reflexes?
• Simple, unlearned, stereotypical responses

• Elicited by certain types of stimulation
• Do not require higher brain functions
− Occur automatically, without thinking
• Most complex motor activities in neonates
• Many have survival value
• Health professionals learn about adequacy of neural functioning by
testing reflexes
What Reflexes Are Shown by Newborns? (1 of 4)
• Reflexes basic to survival

− Rooting reflex
 Baby turns head and mouth toward stimulus that strokes cheek, chin, or
corner of mouth
 Facilitates finding nipple for sucking
− Sucking reflex
 Grows stronger in first days after birth
 Can be lost if not stimulated
 Over months, replaced by voluntary sucking
• Moro (startle) reflex

− Back arches and arms and legs flung out and then brought back toward
chest with arms in hugging motion
− Occurs when baby’s position is suddenly changed or support for head/neck
is suddenly lost
− Can be elicited by loud noises, bumping crib, jerking blanket
− Usually lost by 6–7 months after birth
− Absent Moro reflex can indicate immaturity or brain damage
• Grasping reflex or palmar reflex

− Grasp fingers or other objects pressed against palms of their hands
− Use four fingers, not thumbs
− Reflex stronger when startled
− Most babies can support their own weight by grasping with both hands
when lifted
− Absent grasping reflex can indicate depressed nervous system activity
− Usually lost by 3–4 months of age
− Voluntary grasping generally by 5–6 months
• Stepping reflex
− Mimics walking when held under arms with feet against solid surface
− Usually disappears by 3–4 months of age
• Babinski reflex
− Fans or spreads toes in response to stroking of foot from heel to toes
− Usually disappears toward end of first year, replaced by downward toe curling
− Persistence of reflex may suggest spinal defects, slow nerve development
• Tonic-neck reflex (“fencing position”)
− When lying on back, turns head to one side
− Arm and leg on that side extend; opposite-side limbs flex
How Well Do Neonates Sense the World Around
Them?—Vision (1 of 3)
• Visual acuity
− Estimated to be 20/600 (nearsighted)
− Neonates can see objects best about 7–9 inches away
− Neonates see best through centers of their eyes (no peripheral vision)
− Can detect movement
 Many can track movement the first day after birth
 They appear to prefer moving objects over stationary ones
• Visual accommodation
− Self-adjustments made by lens of the eye to bring objects into focus
− Neonates show little or no visual accommodation
− They focus on objects about 7–9 inches away—about the distance of
caregivers’ faces when cradling them in their arms
• Convergence
− Does not occur until 7–8 weeks of age for near objects (muscular control)
• Color perception
− Degree to which neonates perceive color remains an open question
• Color perception
− Variations in color intensity, saturation, hue
− Rods transmit sensations of light and dark; cones transmit sensations of
color
 At birth, cones are less well developed than rods
− Infants younger than 1 month old do not show ability to discriminate color
differences
− 2-month-olds can discriminate color but require large differences
− By 4 months, infants can see most, if not all, colors of the visible spectrum
Them?—Hearing
• Fetuses respond to sound months before birth
• Neonates can respond to sounds of different amplitude and pitch
• Neonates prefer mothers’ voices
− Hearing may contribute to bonding between neonates and mothers
• Neonates particularly respond to sounds and rhythms of speech
− No preferences for specific languages
− Can discriminate different speech sounds
− Can discriminate between new and familiar speech sounds
How Well Do Neonates Sense the World
Around Them?—Smell
• Neonates can discriminate distinct odors
• They are stimulated by powerful odors and turn away from unpleasant
odors
• Nasal preferences are like those of older children and adults
• Sense of smell may enhance recognition of and attachment to mother
− Neonates less than a week old recognize smell of their mothers’ milk
− Neonates turn toward preferred odors, as those from their mothers
How Well Do Neonates Sense the World
Around Them?—Taste
• Neonates are sensitive to different tastes
• Preferences seem like those of adults
• Neonates discriminate among sweet, salty, sour, and bitter tastes
− They display different facial expressions in response to these
• Sweet tastes have calming effects on neonates
− Preference shown by smiles, licking, eager sucking; increased heart rate,
slower sucking rate
Facial Expressions Elicited by Sweet, Sour, and
Bitter Solutions
Them?—Touch and Pain
• Neonates are sensitive to touch
− Important way of learning and communicating
 Information about environment
 Skin on skin sensations provide feelings of comfort and security important in
forming attachment bonds with caregivers
− Rooting, sucking, Babinski, grasping reflexes activated by pressure on skin
• Neonates are sensitive to pain
− Cognitively, may not think about future or past pain, but can be conditioned
to expect pain in situations like past painful ones
 Anesthetics recommended for circumcision/other painful procedures
On Really Early Childhood “Education”— Can
Neonates Learn?
• Classical conditioning of neonates
− Involuntary responses are conditioned to new stimuli
• Operant conditioning of neonates
− Reflexes are modified through reinforcement
 Sucking reflexes were modified in The Cat in the Hat study
• Reinforcers must be administered rapidly for learning to occur
− The younger the child, the sooner
 Within 1 second for neonates
 Within 2 seconds for infants 6–8 months old
What Patterns of Sleep and Waking Are Found
Among Neonates?
• Neonates sleep about 16 hours a day
− A typical neonate has about six cycles of waking and sleeping per 24 hours
− By about 6 months to a year, many infants begin sleeping through the night
• REM sleep
− Neonates spend about half their sleeping time in REM sleep
− By ~6 months, REM drops to 30% of sleep; by 2–3 years, 20–25% of sleep
− May be for internal brain stimulation
 Neonates get less of this when awake than older children and adults do
REM Sleep and Non-REM Sleep
Figure 4.8: REM Sleep and Non-REM Sleep

Neonates spend nearly 50% of their time
sleeping in rapid eye movement (REM) sleep.
The percentage of time spent in REM sleep
drops off to 20–25% for 2-to 3-year-olds.
Source: Roffwarg et al. (1966).
Why Do Babies Cry? What Can Be Done to Soothe
Them? (1 of 2)
• Pain
− Close physical contact is most helpful maternal response
• Communication
− Universal
− Expressive
 Response to unpleasant feelings
− Functional
 Stimulates response from caregiver
Why Do Babies Cry? What Can Be Done to
Soothe Them? (2 of 2)
• Parents learn to distinguish cries from hunger, anger, pain, or colic
• Parents and others, including children, have similar bodily responses to
infant crying
• Distinct patterns of crying
− Health problems
− Peaks of crying in late afternoon and early evening
− Duration of crying bouts decreases by half during first 9 months or so
Soothing a Crying Infant
• Skin-to-skin physical contact

• Sucking
− On a pacifier
− On sweet solutions
• Patting, caressing, rocking, swaddling
• Speaking to them in a soft voice
• Finding cause of distress
− Checking diaper
− Offering bottle or pacifier
4.6 Sudden Unexpected Infant
Death and Sudden Infant Death
Syndrome
Sudden Unexpected Infant Death and Sudden
Infant Death Syndrome
• Sudden unexpected infant death (SUID)
− Sudden infant death syndrome (SIDS)
− Accidental suffocation in sleeping environment
− Other deaths whose causes are generally unknown
− SIDS or crib death
 Baby appears perfectly healthy
 Occurs during sleep
 No signs of struggle or pain
Sudden Infant Death Syndrome
• Most common cause of death in first year, mostly between 2 and 5 months
• More common among:
− Babies age 2–4 months
− Babies put to sleep on stomachs or sides
− Premature and low-birth-weight infants
− Male babies
− Bottle-fed babies
− African American babies
− Babies of teen mothers
− Babies whose mothers smoked during/after pregnancy or used narcotics during
pregnancy
The Children’s Hospital Boston Study
• Paterson et al. (2006)

• Focused on medulla in the brainstem
− Medulla causes us to breathe when we need oxygen
− Babies who died of SIDS were less sensitive to serotonin than babies who
died at same age of other causes
 Serotonin helps keep the medulla responsive
− Problem particularly striking in boys
− More recent studies confirm key role of serotonin in medulla
Precautions to Guard Against SIDS (1 of 2)
From American Academy of Pediatrics (2016):

• Always place baby on back to sleep
• Firm sleep surface
• Breastfeed for as long as possible
• Put baby in your room but not in your bed
• Keep soft objects, loose bedding, and so on out of crib
• Consider offering pacifier at nap and sleep times
Precautions to Guard Against SIDS (2 of 2)
• Avoid exposure to smoke and use of drugs during pregnancy and after birth
• Do not let baby get overheated
• Get regular prenatal care
• Immunize infants according to schedules from American Academy of Pediatrics
and the Centers for Disease Control and Prevention (see Chapter 8)
• Do not use home cardiorespiratory monitors to help reduce risk of SIDS
• Use healthcare providers who endorse these recommendations
Self-Assessment
• Which facts and/or concepts in this chapter did you find most
challenging, and hence need to review?
• Which things did you learn from this chapter that surprised you and/or
changed some misconceptions you may have had?
• Which things you learned from this chapter do you find most valuable for
applying in your own life, like in your job, family, or relationships?
Summary
Now that the lesson has ended, you should have learned how to:
• Describe the three stages of childbirth.
• Discuss methods of childbirth, focusing on ways of alleviating the discomfort of
childbirth and on cesarean delivery (C-sections).
• Discuss birth problems, including the effects of oxygen deprivation and on
preterm delivery and low-birth-weight babies.
• Discuss issues that occur during the postpartum period, including possible
psychological challenges experienced by mothers, and parental–infant
bonding.
• Describe the characteristics of neonates.
• Discuss sudden unexpected infant death and sudden infant death syndrome.

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Childhood and

By the end of this chapter, you will be able to:

• Indigestion, diarrhea, backache, and abdominal cramps are common

• Babies placed in incubators

Figure 4.5 Infant Mortality Rates by State

• Simple, unlearned, stereotypical responses

• Reflexes basic to survival

• Moro (startle) reflex

• Grasping reflex or palmar reflex

Figure 4.8: REM Sleep and Non-REM Sleep

• Skin-to-skin physical contact

• Paterson et al. (2006)

From American Academy of Pediatrics (2016):

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