Birth

Major Transition

• Protected uterine environment to the highly stimulating outside world

• The nature of the transition can have an impact on developmental outcome for the newborn

Traditional Birth

• Hospital births are still the most common birthing method in North America

• Many adjustments have been made in contemporary practice to make the process more natural for infants and families

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Birthing Methods

• Natural vs. technology– Alternatives and accommodations

• Leboyer, Lamaze

• Outcomes

• Cross Cultural

Alternative Birthing Methods

• Lamaze– training in muscle relaxation techniques, coaching, and education

• Leboyer (Gentle Birth)– focus on gentle transition for the infant•includes subdued stimulation (lights,sound), skin/skin contact and massage, delay cord clamping, warm water bath, extended postpartum contact

Research: Alternative Methods

• Hughey et al – 500 Lamaze and Controls– fewer C-sections, fetal distress, perinatal

mortality, postpartum infections, premature births, episiotomies, maternal hypertension

• Oliver & Oliver – 20 Leboyer and Controls–more relaxed and alert at birth, soft

vocalizations, muscle relaxation

Birth Complications • Natural Complications

– breech birth and placenta previa: primary risk is respiratory distress/anoxia for both

• Complications from Medical Interventions– anesthetics: immature liver and kidneys put infant at risk for eliminating the drugs

– forceps/suction: structural damage to skull, potential for brain damage

– induction drugs: contractions usually more frequent and stronger, potential for anoxia

Prematurity

• Born <37 weeks gestation (Normal range 37-43 weeks)

• 80% survival when greater than 2.25 lbs

• Distinction between premature and small for dates, which refers to weight of infant being low for gestational age

Premature Birth

• Typically premature births involve Cesarean Section, especially if there is respiratory distress

• Reason for prematurity dictates viability of outcome

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Prematurity, cont’d• Major causes

– teratogens– placenta previa

• Factors affecting viability– birthweight (small for dates more at risk)

– respiratory distress most likely cause of premature infant death

– cause of prematurity (inherent in that infant’s development or outside influence)

Prematurity cont’d• Interventions can have positive impact– medical interventions (respirator, oxygen rich air, incubator for temperature control, etc)

– breastmilk (higher fat/protein ratio than full term milk)

– caregiver bonding (facilitates growth)– stimulation (at appropriate levels speeds weight gain and growth)

– massage (found to facilitate physical, mental and motor development)

Breathing Teddy Bear

• Thoman et al 1995– Many premature

infants suffer from breathing difficulties

– Teddy Bear connected to air pump and breathes beside infant

– Helps to establish regular breathing pattern

Newborn Abilities

Physical State

• Apgar Scale

– quick test to screen for emergency care

– 1 min and 5 min tests • heart rate• respiratory effort • muscle tone• reflex responsivity• color (highest score is 10, 4 is low)

Behavior

• Brazelton test– reflexes – motor capacities – muscle tone – responses to object and people– capacity to control own behavior – attention

Newborn Reflexes

• Inborn, automatic responses to a particular form of stimulation

• Give quick indication of neurological functioning

• Some refined with practice to become complex patterns of behavior

• Others drop out

Common Reflexes– Babinski

• fanning out of toes when foot stroked

– Crawling • rythmic moving of arms and legs when on tummy and pressure applied to soles of feet

– Grasping• finger grasp when object placed in hand

– Rooting• head turn with mouth open when touched on cheek

– Moro• outstretched arms & arched back when startled or loss of support

– Stepping• toes and foot coordinated movements when supported on a hard surface, moved forward

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Functions of Reflexes– survival value

•some are refined with practice & develop into complex behaviors (e.g., sucking); others drop out, no longer of value (e.g., Moro)

– links to later motor development•tonic neck may prepare for later reaching, stepping may be linked to walking (Zelazo), stepping drops out temporarily due to inability to support weight (Thelen study shows reflex still present in water)

– linked to early social relationships• burst/pause rhythm of early feeding may predate turn-taking in early social interactions, mom stimulates sucking (Kaye & Wells)

Sensory Abilities• Touch

– Temperature change

– Pain? •e.g., circumcision - physiological indicators (crying, stress hormones, hard to comfort, etc) suggest pain, however, what about cognitive components of pain

– Massage•positive benefits for preterm infants, infants of depressed moms (and their moms), sexually abused infants, HIV infants, addicted infants (Field)

Sensory Abilities, cont’d

• Taste– strong preferences as indicated by sucking patterns and facial expressions (Lipsitt)

– differences in mouth chemistry until adolescence•e.g., salty fluid that would be rejected by older children and adults will be ingested by infants

Sensory Abilities, cont’d

• Smell– MacFarlane research shows that breastfed

newborns can discriminate, and prefer (turn toward), their mom’s scent from lactating stranger

– Cernoch & Porter research shows bottle fed infants prefer (turn toward) scent of lactating females but can’t discriminate mom from stranger

Sensory Abilities, cont’d• Sound

– DeCasper’s work shows ability of newborns to discriminate mom’s voice from female stranger, and to discriminate a familiar from a novel story read by mom

– Sullivan & Horowitz study shows preference for high intonation and exaggerated rhythms of infant directed speech

– Eimas & Jusyck and Werker argue for preparedness for language

• E.g., NB’s ability to discriminate the sounds of speech from any language

Research Setup for Speech Perception Studies with Infants

Dishabituation Results from Eimas’ Categorical Speech Perception Experiment

Categorical Perception of Speech Sounds from NonNative Languages Diminishes During Year 1

Sensory Abilities, cont’d

• Sound, cont’d– Clifton’s research shows that infant’s world is

full of reflected sound (echo) and with cortical development infant becomes able to shut out echo and attend to the message

• E presented sound from one speaker for # trials training infant to turn toward sound, then played echo of sound from another speaker at same time. Adults don’t hear echo, infants confused

Sensory Abilities, cont’d

• Vision– acuity estimated to be 20/660 – good at 8-10 in– eye movements/scanning of objects focuses

on one part of object– colour vision poor, due to disorganized retina

Dramatic Increase in Visual Acuity over First 3 months

States of the Newborn• Individual differences

– Wolff’s study showing changes from sleep to drowsy to alert to distress (Figure 4.20)

– Cultural effects on all states

• Sleep– REM sleep associated with dreams, high in NB– nonREM sleep associated with regular quiet sleep, slow

heartrate and breathing, low in NB– patterns change by 2-3 mo showing more adult balance

of nonREM/REM– sleeping arrangements vary across cultures

States of the Newborn, cont’d• Feeding

– higher rate of crying in babies with imposed 4hr schedule of feedings compared to ‘on demand’

• Crying– usually caused by physical need – emotional contagion– survival function may be to get attention of

caregiver – cultural differences in irritability often has to do

with level of physical contact