Birth

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Birth
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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

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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

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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

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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

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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

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Prematurity

• Born lt37 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

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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, contd

• 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 infants
  development or outside influence)

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Prematurity contd

• 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)

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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

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Newborn Abilities
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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)

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Behavior

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

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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

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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)

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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)

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Sensory Abilities, contd

• 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

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Sensory Abilities, contd

• Smell
• MacFarlane research shows that breastfed newborns
  can discriminate, and prefer (turn toward), their
  moms scent from lactating stranger
• Cernoch Porter research shows bottle fed
  infants prefer (turn toward) scent of lactating
  females but cant discriminate mom from stranger

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Sensory Abilities, contd

• Sound
• DeCaspers work shows ability of newborns to
  discriminate moms 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., NBs ability to discriminate the sounds of
  speech from any language

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Research Setup for Speech Perception Studies with
Infants
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Dishabituation Results from Eimas Categorical
Speech Perception Experiment
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Categorical Perception of Speech Sounds from
NonNative Languages Diminishes During Year 1
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Sensory Abilities, contd

• Sound, contd
• Cliftons research shows that infants 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 dont hear echo, infants confused

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Sensory Abilities, contd

• 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

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Dramatic Increase in Visual Acuity over First 3
months
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States of the Newborn

• Individual differences
• Wolffs 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

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States of the Newborn, contd

• 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

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