Periods of development

 Periods of development:

Prenatal period: from conception to birth

Infancy and toddlerhood: birth to 2 years

Early childhood: 2-6 years old

Adolescence: 12-19 years old

Middle & late childhood: 6-12 years old

Early Adulthood: begins in the begins in the late teens or early twenties and lasts through the thirties.

Middle Adulthood: from 40 years of age to about 60. 

Late Adulthood: begins in the sixties or seventies and lasts until death. - the young old, or old age, and the old old, or late old age.

Prenatal period:  from conception to birth. It involves tremendous growth—from a single cell to an organism complete with brain and behavioral capabilities, produced in approximately a nine-month period.

Infancy:  from birth to 18 or 24 months. It is a time of extreme dependence upon adults. Many psychological activities are just beginning—language, symbolic thought, sensorimotor coordination, and social learning, for example.

Early childhood: from the end of infancy to about 5 or 6 years. It sometimes called the “preschool years.” During this time, children learn to become more self-sufficient and to care for themselves, develop school readiness skills (following instructions, identifying letters), and spend many hours in play with peers. First grade typically marks the end of early childhood.

Middle and late childhood:  from about 6 to 11 years of age. It is called as the “elementary school years.” The fundamental skills of reading, writing, and arithmetic are mastered. The child is formally exposed to the larger world and its culture. Achievement becomes a more central theme of the child’s world, and self-control increases.

Adolescence : period of transition from childhood to early adulthood, entered at 10 to 12 years of age and ending at 18 to 22 years of age. A rapid physical changes begins—dramatic gains in height and weight, changes in body contour, and the development of sexual characteristics such as enlargement of the breasts, development of pubic and facial hair, and deepening of the voice. At this point pursuit of independence and an identity are prominent. Thought is more logical, abstract, and idealistic. More time is spent outside the family.

Early adulthood: begins in the late teens or early twenties and lasts through the thirties. It is a time of establishing personal and economic independence, career development, and, for many, selecting a mate, learning to live with someone in an intimate way, starting a family, and rearing children.

Middle adulthood: from 40 years of age to about 60. It is a time of expanding personal and social involvement and responsibility; of assisting the next generation in becoming competent, mature individuals; and of reaching and maintaining satisfaction in a career.

Late adulthood: begins in the sixties or seventies and lasts until death. It is a time of adjustment to decreasing strength and health, life review, retirement, and adjustment to new social roles.

Life-span developmentalists increasingly distinguish between two age groups in late adulthood: the young old, or old age, and the old old, or late old age. Still others distinguish the oldest old (85 years and older) from younger older adults.

The Young Old (65 to 84)

:Increase their life expectancy with more older adults living longer

Have considerable potential for improved physical and cognitive fitness

Retain much of their cognitive capacity

Can develop strategies to cope with the gains and losses of aging

.The Oldest Old (85 and older): 

Show considerable loss in cognitive skills

Experience an increase in chronic stress

Alzheimer disease more common and individuals more frail

Dying with dignity less likely

.

Domains of Development

 Domains of Development

Development is described in three domains, but growth in one domain influences the other domains.

Physical Domain: 

body size, body proportions, appearance, brain development, motor development, perception capacities, physical health.

Cognitive Domain:

thought processes and intellectual abilities including attention, memory, problem solving, imagination, creativity, academic and everyday knowledge, metacognition, and language.

Social/Emotional Domain:

self-knowledge (self-esteem, metacognition, sexual identity, ethnic identity), moral reasoning, understanding and expression of emotions, self-regulation, temperament, understanding others, interpersonal skills, and friendships.

Early and Late Maturation

 Early and Late Maturation:

When adolescents mature earlier or later than their peers, they often perceive themselves differently and their maturational timing is linked to their socioemotional development and whether they develop problems.

 In the Berkeley Longitudinal Study, early-maturing boys perceived themselves more positively and had more successful peer relations than did latematuring boys.

 The findings for early-maturing girls were similar but not as strong as for boys.

When the late-maturing boys were in their thirties, they had developed a more positive identity than the earlymaturing boys had.

Perhaps the late-maturing boys had more time to explore life’s options, the early-maturing boys continued to focus on their physical status instead of paying attention to career development and achievement.

 The early maturation increases girls’ vulnerability to a number of problems.

Early-maturing girls are more likely to smoke, drink, be depressed,  have an eating disorder, struggle for earlier independence from their parents, and have older friends; and their bodies are likely to elicit responses from males that lead to earlier dating and earlier sexual experiences.

 Recent study revealed that early-maturing girls were more likely to try cigarettes and alcohol without their parents’ knowledge.

--are less likely to graduate from high school and tend to cohabit and marry earlier.

--social and cognitive immaturity, combined with early physical development, early-maturing girls are easily lured into problem behaviors, not recognizing the possible long-term effects of these on their development. 

ADOLESCENCE Determinants of Puberty

 ADOLESCENCE

Puberty is a period of rapid physical maturation involving hormonal and bodily changes that occur primarily in early adolescence.

The features and proportions of the body change as the individual becomes capable of reproducing.

 Determinants of Puberty:

Puberty is not the same as adolescence.

--as the most important marker for the beginning of adolescence.

 Puberty might begin as early as 10 years of age or as late as 13½ for boys.

It might end as early as 13 years or as late as 17 years.

 In fact, over the years the timing of puberty has changed.

For example, in Norway, menarche—a girl’s first menstruation—now occurs at just over 13 years of age, compared with 17 years of age in the 1840s.

 United States, where children mature up to a year earlier than in European countries.

 The normal range for the onset and progression of puberty for Girls occurs between the ages of 9 and 15.

 Precocious puberty is the term used to describe the very early onset and rapid progression of puberty.

 Judith Blakemore and her colleagues (2009) recently described the following characteristics of precocious puberty:

--pubertal onset occurs before 8 years of age in girls and before 9 years of age in boys.

--10 times more often in girls than in boys.

 It usually is treated by medically suppressing gonadotropic secretions, which temporarily stops pubertal change.

 The reasons for this treatment is that children who experience precocious puberty are ultimately likely to have short stature, early sexual capability, and the potential for engaging in age-inappropriate behavior.

Among the most important factors that influence the onset and sequence of puberty are heredity, hormones, weight, and body fat.

1. Heredity --Puberty is not an environmental accident. It does not take place at 2 or 3 years of age, and it does not occur in the twenties.

Programmed into the genes of every human being.

2. Hormones-- Behind the first whisker in boys and the widening of hips in girls is a flood of hormones.

Hormones are powerful chemical substances secreted by the endocrine glands and carried through the body by the bloodstream.

 It is controlled by the interaction of the

 The hypothalamus is a structure in the brain best known for hypothalamus, the pituitary gland, and the gonads (sex glands). -- monitoring eating, drinking, and sex.

 The pituitary gland is an important endocrine gland that controls growth and regulates other glands.

 The gonads are the sex glands—the testes in males, the ovaries in females.

 The key hormonal changes involve two classes of hormones  

--in males and females are: Androgens and Estrogens.

 Testosterone is an androgen that is a key hormone in the development of puberty in boys.

As the testosterone level rises during puberty, external genitals enlarge, height increases, and the voice changes.

 

Estradiol is an estrogen that plays an important role in female pubertal development.

As the estradiol level rises, breast development, uterine development, and skeletal changes occur.

 Are there links between hormones and adolescent behavior? Findings are inconsistent.

For example, one study found that social factors accounted for two to four times as hormonal factors in young adolescent girls’ depression and anger.

 Hormones do not act independently; hormonal activity is influenced by many environmental factors,

including parentadolescent relationships.

 Stress, eating patterns, sexual activity, and depression can also activate or suppress various aspects of

the hormone system.

 Growth Spurt: The rapid increases in growth since infancy.

The growth spurt associated with puberty occurs approximately two years earlier for girls than for boys.

(9 years of age for girls and 11 years of age for boys -USA).

 Boys and girls who are shorter or taller than their peers at the beginning of adolescence, girls are taller than boys, but later years most boys have taller than girls.

 

Sexual Maturation:

FOR BOYS: increase in penis and testicle size, appearance of straight pubic hair, minor voice change, first ejaculation (which usually occurs through masturbation or a wet dream), appearance of pubic hair, onset of maximum body growth, growth of hair in armpits, more detectable voice changes, and growth of facial hair.

 Three of the most noticeable areas of sexual maturation in boys are penis elongation, testes development, and growth of facial hair.

 FOR GIRLS:  First, on average the breasts enlarge and then pubic hair appears.

---the female grows in height, and her hips become wider than her shoulders.

Her first menstruation (menarche) occurs rather late in the pubertal cycle; it is considered normal if it occurs between the ages of 9 and 15.

 Pubertal females do not experience voice changes comparable to those in pubertal males.

By the end of puberty, the female’s breasts have become more fully rounded.

 

Body Image:

One psychological aspect of physical change in puberty is certain: Adolescents are preoccupied with their bodies and develop images of what their bodies are like.

 Preoccupation with body image is strong throughout adolescence and dissatisfied with their bodies than in late adolescence.

 Gender differences characterize adolescents’ perceptions of their bodies.

In general, girls are less happy with their bodies and have more negative body images than boys throughout puberty.

 As pubertal change proceeds, girls often become more dissatisfied with their bodies, probably because their body fat increases.

In contrast, boys become more satisfied as they move through puberty, probably because their muscle mass increases.

 Also some variations, keep in mind that there is considerable variation, with many adolescent girls having positive body images and many adolescent boys having negative body images.

Middle and Late Childhood

Middle and Late Childhood

--from about 6 to 11 years of age

—involves slow, consistent growth.

 

During the elementary school years, children grow an average of 2 to 3 inches a year.

At the age of 8 the average girl and the average boy are 4 feet 2 inches tall.

--weigh 56 pounds (National Center for Health Statistics, 2000).

--The weight increase is due to the size of the skeletal and muscular systems, as well as the size of some body organs.

 

Muscle mass and strength gradually increase as “baby fat’’ decreases in middle and late childhood.

 

The increase in muscular strength is due to heredity and to exercise.

--more the muscle cells, boys tend to be stronger than girls.

 

During the middle and late childhood years, children gain about 5 to 7 pounds a year.

 

Changes in physical proportions are:  Head circumference, waist circumference, and leg length decrease in relation to body height.

Overview of Child Development

 Overview of Child Development

Definition:

Change in the child that occurs over time.  Changes follow an orderly pattern that moves toward greater complexity and enhances survival.

Origins of Child Development Theories

6th - 15th centuries Medieval period

Preformationism: children seen as little adults.

Childhood is not a unique phase.

Children were cared for until they could begin caring for themselves, around 7 years old.

Children treated as adults (e.g. their clothing, worked at adult jobs, could be married, were made into kings, were imprisoned or hanged as adults.)

16th Century Reformation period

Puritan religion influenced how children were viewed.

Children were born evil, and must be civilized. 

A goal emerged to raise children effectively. 

Special books were designed for children.

17th Century Age of Enlightenment

John Locke believed in tabula rasa

Children develop in response to nurturing.

Forerunner of behaviorism

18th Century Age of Reason

Jean-Jacques Rousseau

 - children were noble savages, born with an innate sense of morality; the timing of growth should not be interfered with.

Rousseau used the idea of stages of development.

Forerunner of maturationist beliefs

19th Century Industrial Revolution

Charles Darwin 

theories of natural selection and survival of the fittest 

Darwin made parallels between human prenatal growth and other animals.

Forerunner of ethology

20th Century

Theories about children's development expanded around the world. 

Childhood was seen as worthy of special attention.

Laws were passed to protect children, 

Outline of 20th Century Theories

Psychoanalytical Theories

Psychosexual: Sigmund Freud

Psychosocial: Erik Erikson

Behavioral & Social Learning Theories

Behaviorism: Classical Conditioning - John Watson & Operant Conditioning - B.F. Skinner

Social Learning - Albert Bandera

Biological Theories

Maturationism: G. Stanley Hall & Arnold Gesell

Ethology: Konrad Lorenz

Attachment: John Bowlby

Cognitive Theories

Cognitive Development: Jean Piaget

Socio-cultural: Lev Vygotsky

Information Processing

Systems Theories

    Ecological Systems: Urie Bronfenbrenner

Cultural Believes About Pregnancy

 Cultural Believes About Pregnancy

All cultures have beliefs and rituals that surround life's major events, including pregnancy. Some cultures treat pregnancy simply as a natural occurrence; others see it as a medical condition. Obtaining medical care during pregnancy may not seem important to a woman of whose culture defines pregnancy as a natural condition.

How expectant mothers behave during pregnancy may depend in part on the prevalence of traditional home-care remedies and folk beliefs, the importance of indigenous healers, and the influence of health-care professionals in their culture. For example, some Filipinos will not take any medication during pregnancy. Many Mexican American women seek advice about their pregnancy from their mothers and from older women in the community. They may also call on an indigenous healer known as a curandero. In various cultures pregnant women may turn to herbalists, faith healers, root doctors, or spiritualists or help.

When health-care professionals work with expectant mothers, cultural assessment should be an important component of their care.

In other words, they should identify beliefs, values, and behaviors related to childbearing. In particular, ethnic background, degree of affiliation with the ethnic group, patterns of decision making, religious preference, language, communication style, and etiquette may all affect a woman's attitudes about the care needed during pregnancy. Health care workers should assess whether a woman's beliefs or practices pose a threat to her or the fetus. If they do, healthcare professionals should consider a culturally sensitive way to handle the problem.

PRENATAL DIAGNOSTIC TESTS

 PRENATAL DIAGNOSTIC TESTS

One choice open to prospective mothers is the option to undergo prenatal testing. A number of tests can indicate whether a fetus is developing normally, including ultrasound sonography, fetal MRI, chorionic villus sampling, amniocentesis, maternal blood screening, and noninvasive prenatal diagnosis (Lenzi & Johnson, 2008).

An ultrasound test is often conducted seven weeks into a pregnancy and at various times later in pregnancy (Cignini & others, 2010). Ultrasound sonography is a prenatal medical procedure in which high-frequency sound waves are directed into the pregnant woman’s abdomen. The echo from the sounds is transformed into a visual representation of the fetus’s inner structures. This technique can detect many structural abnormalities in the fetus, including microencephaly, a form of mental retardation involving an abnormally small brain; it can also determine the number of fetuses and give clues to the baby’s sex (Gerards & others, 2008). There is virtually no risk to the woman or fetus in this test.

The development of brain-imaging techniques has led to increasing use of fetal MRI to diagnose fetal malformations (Daltro & others, 2010; Duczkowska & others, 2010) (see Figure 2.7). MRI stands for magnetic resonance imaging and uses a powerful magnet and radio images to generate detailed images of the body’s organs and structures. Currently, ultrasound is still the first choice in fetal screening, but fetal MRI can provide more detailed images than ultrasound. In many instances, ultrasound will indicate a possible abnormality and then fetal MRI will be used to obtain a clearer, more detailed image (Obenauer & Maestre, 2008). Among the fetal malformations that fetal MRI may be able to detect better than ultrasound sonography are certain abnormalities of the central nervous system, chest, gastrointestinal tract, genital/urinary system, and placenta (Baysinger, 2010; Panigraphy, Borzaga, & Blumi, 2010; Weston, 2010), motivation to terminate a pregnancy (Benn & Chapman. 2010).

At some point between the 10th and 12th weeks of pregnancy, chorionic villus sampling may be used to detect genetic defects and chromosomal abnormalities such as those discussed in the previous section. Chorionic villus sampling (CVS) is a prenatal medical procedure in which a small sample of the placenta (the vascular organ that links the fetus to the mother’s uterus) is removed. Diagnosis takes about 10 days. There is a small risk of limb deformity when CVS is used.

Between the 15th and 18th weeks of pregnancy, amniocentesis may be performed. Amniocentesis is a prenatal medical procedure in which a sample of amniotic fluid is withdrawn by syringe and tested for chromosomal or metabolic disorders (Nagel & others, 2007). The amnionic fluid is found within the amnion, a thin sac in which the embryo is suspended. Ultrasound sonography is often used during amniocentesis so that the syringe can be placed precisely. The later in the pregnancy amniocentesis is performed, the better its diagnostic potential. The earlier it is performed, the more useful it is in deciding how to handle a pregnancy. It may take two weeks for enough cells to grow and amniocentesis test results to be obtained. Amniocentesis brings a small risk of miscarriage: about 1 woman in every 200 to 300 miscarries after the procedure.

Both amniocentesis and chorionic villus sampling provide valuable information about the presence of birth defects, but they also raise difficult issues for parents about whether an abortion should be obtained if birth defects are present (Quadrelli & others, 2007; Zhang & others, 2010). Chorionic villus sampling allows parents to make a decision sooner, near the end of the first 12 weeks of pregnancy, when abortion is safer and less traumatic than later. Although earlier reports indicated that chorionic villus sampling brings a slightly higher risk of pregnancy loss than amniocentesis, a recent U.S. study of more than 40,000 pregnancies found that loss rates for CVS decreased over the period from 1998 to 2003 and that there is no longer a difference in pregnancy loss risk between CVS and amniocentesis (Caughey, Hopkins, & Norton, 2006).

During the 16th to 18th weeks of pregnancy, maternal blood screening may be performed. Maternal blood screening identifies pregnancies that have an elevated risk for birth defects such as spina bififida (a defect in the spinal cord) and Down syndrome (Bustamante-Aragones & others, 2010). The current blood test is called the triple screen because it measures three substances in the mother’s blood. After an abnormal triple screen result, the next step is usually an ultrasound examination. If an ultrasound does not explain the abnormal triple screen results, amniocentesis is typically used.

Noninvasive prenatal diagnosis (NIPD) is increasingly being explored as an alternative to procedures such as chorionic villus sampling and amniocentesis (Susman & others, 2010). At this point, NIPD has mainly focused on the isolation and examination of fetal cells circulating in the mother’s blood and analysis of cell-free fetal DNA in maternal plasma (Prakash, Powell, & Geva, 2010).

Researchers already have used NIPD to successfully test for genes inherited from a father that cause cystic fibrosis and Huntington disease. They also are exploring the potential for using NIPD to identify a baby’s sex as early as five weeks after conception and to diagnose Down syndrome (Avent & others, 2008). Being able to detect an offspring’s sex and various diseases and defects so early raises ethical concerns about couples’ motivation to terminate a pregnancy (Benn & Chapman, 2010).

BONDING

 BONDING

A special component of the parent-infant relationship is bonding, the formation of a connection, especially a physical bond between parents and the newborn in the period shortly after birth. Sometimes hospitals seem determined to deter bonding. Drugs given to the mother to make her delivery less painful can make the mother drowsy, interfering with her ability to respond to and stimulate the newborn. Mothers and newborns are often separated shortly after delivery, and preterm infants are isolated from their mothers even more than full-term infants.

Do these practices do any harm? Some physicians believe that during the period shortly after birth, the parents and newborn need to form an emotional attachment as a foundation for optimal development in years to come. Is there evidence that close contact between mothers in the first several days after birth is critical for optimal development later in life? Although some research supports this bonding hypothesis (Klaus & Kennell, 1976), a body of research challenges the significance of the first few days of life as a critical period (Bakeman & Brown, 1980; Rode & others, 1981). Indeed, the extreme form of the bonding hypothesis—that the newborn must have close contact with the mother in the first few days of life to develop optimally—simply is not truembonding hypothesis should not be used mother-infant pairs-including preterm infants, adolescent mothers, and mothers from disadvantaged circumstances—early close contact may establish a climate for improved interaction after the mother and infant leave the hospital. Many hospitals now offer a rooming-in arrangement, in which the baby remains in the mother's room most of the time during its hospital stay. However, if parents choose not to use this rooming-in arrangement, the weight of the research suggests that this decision will not harm the infant emotionally.

POSTPARTUM PERIOD

 THE POSTPARTUM PERIOD

The weeks after childbirth present challenges for many new parents and their offspring. This is the postpartum period    the period after childbirth or delivery that lasts for about six weeks or until the mother's body has completed its adjustment and has returned to a nearly prepregnant state. It is a time when the woman adjusts, both physically and psychologically, to the process of childbearing.  The postpartum period involves a great deal of adjustment and adaptation. The adjustments needed are physical, emotional, and psychological.  A woman's body makes numerous physical adjustments in the first days and weeks after childbirth (Mattson & Smith, 2011). She may have a great deal of energy or feel exhausted and let down. Though these changes are normal, the fatigue can undermine the new mother's sense of well-being and confidence in her ability to cope with a new baby and a new family life (Runquist, 2007).

 

PHYSICAL ADJUSTMENTS

A concern is the loss of sleep that the primary caregiver experiences in the postpartum period (Gunderson & others, 2008). In the 2007 Sleep in America survey, a substantial percentage of women reported loss of sleep during pregnancy and in the postpartum period. The loss of sleep can Contribute to Stress, marital Conflict, and impaired decision making. Alter delivery, a mother s body undergoes sudden and dramatic changes in hormone production. When the placenta is delivered, estrogen and progesterone levels drop steeply and remain low until the ovaries start producing hormones again.

Involution is the process by which the uterus returns to its prepregnant size five or six weeks after birth. Immediately following birth, the uterus weighs 2 to 3 pounds. By the end of five or six weeks, the uterus weighs 2 to 3V2 ounces. Nursing the baby helps contract the uterus at a rapid rate.

 

 

EMOTIONAL AND PSYCHOLOGICAL ADJUSTMENTS

Emotional fluctuations are common for mothers in the postpartum period. For some women, emotional fluctuations decrease within several weeks after the delivery, but other women experience more long-lasting emotional swings.  As shown in Figure 3.11, about 70 percent Of new mothers in the United States have what are called the postpartum blues. About two to three days after birth, they begin to feel depressed, anxious, and upset. These feelings may come and go for several months after the birth, often peaking about three to five days after birth. Even without treatment, these feelings usually go away after one or two weeks.  However, some women develop postpartum depression which involves a major depressive episode that typically occurs about four weeks after delivery. In other words, women with postpartum depression have such strong feelings of sadness, anxiety, or despair that for at least a two-week period they have trouble coping with their daily tasks. Without treatment, postpartum depression may become worse and last for many months (Nolen-Hoeksema, 2011). And many women with postpartum treatment don't seek help. For example, one recent study found that 15 percent of the women reported postpartum depression symptoms but less than half sought help (McGarry & others, 2009). Estimates indicate that 10 to 14 percent of new mothers experience postpartum depression.

Several antidepressant drugs are effective in treating postpartum depression and appear to be safe for breast feeding women (Logsdon, Wisner, & Hanusa, 2009). Psychotherapy, especially cognitive therapy, also is an effective treatment of postpartum depression for many women (Beck, 2006). Also, engaging in regular exercise may help in treating postpartum depression (Daley, Macarthur, & Winter, 2007).

Can a mother's postpartum depression affect the way she interacts with her infant? A recent research review concluded that the interaction difficulties of depressed mothers and their infants occur across cultures and socioeconomic status groups, and encompass less sensitivity of the mothers and less responsiveness on the part of their infants (Field, 2010). Several caregiving activities also are compromised, including feeding (especially breast feeding), sleep routines, and safety practices. To read about one individual who specializes in women's adjustment during the postpartum period.  Fathers also undergo considerable adjustment in the postpartum period, even when they work away from home all day. Many fathers feel that the baby comes first and gets all of the mother's attention; some feel that they have been replaced by the baby. The father's support and caring can play a role in whether the mother develops postpartum depression or not. A recent study revealed that higher support by fathers was related to lower incidence of postpartum depression in women (Smith & Howard, 2008).

PRETERM AND LOW BIRTH WEIGHT INFANTS

 

PRETERM AND LOW BIRTH WEIGHT INFANTS

Different conditions that pose threats for newborns have been given different labels. We will examine these conditions and discuss interventions for improving outcomes of preterm infants.

Preterm and Small for Date Infants

Three related conditions pose threats to many newborns: low birth weight, being preterm, and being small for date. Low birth weight infants weigh less than 5½ pounds at birth.Very low birth weight newborns weigh under 3½ pounds, and extremely low birth weight newborns weigh under 2 pounds. Preterm infants are those born three weeks or more before the pregnancy has reached its full term—in other words, before the completion of 37 weeks of gestation (the time between fertilization and birth). Small for date infants (also called small for gestational age infants) are those whose birth weight is below normal when the length of the pregnancy is considered. They weigh less than 90 percent of all babies of the same gestational age. Small for date infants may be preterm or full term. One study found that small for date infants had more than a fourfold risk of death (Regev & others, 2003).

Consequences of Preterm Birth and Low Birth Weight

Although most preterm and low birth weight infants are healthy, as a they have more health and developmental problems than normal birth weight infants (Minde & Zelkowitz, 2008). For preterm birth, the terms extremely preterm and very preterm are increasingly used (Lowdermilk, Perry, &Cashion, 2011). Extiemely preterm infants are those born less than 28 weeks preterm, and very preterm infants are those born less than 33 weeks of gestational age.

The number and severity of these problems increase when infants are born very early and as their birth weight decreases. Survival rates for infants who are born very early and very small have risen, but with this improved survival rate have come increases in rates of severe brain damage (Casey, 2008).

Children born low in birth weight are more likely than their normal birth weight counterparts to develop a learning disability, attention deficit hyperactivity disorder, or breathing problems such as asthma.

Nurturing Low Birth Weight and Preterm Infants

Two increasingly used interventions in the neonatal intensive care unit (NICU) are kangaroo care and massage therapy. Kangaroo care involves skin-to-skin contact in which the baby, wearing only a diaper, is held upright against the parent's bare chest, much as a baby kangaroo is carried by its mother (Ludington-Hoc & others, 2006). Kangaroo care is typically practiced for two to three hours per day, skin-to-skin over an extended time in early infancy.

Why use kangaroo care with preterm infants? Preterm infants often have difficulty coordinating their physical contact with the parent provided by kangaroo care can help to stabilize the preterm infant's heartbeat, temperature, and breathing. Preterm infants who experience kangaroo care also gain more weight than their counterparts who are not given this care. A recent study also revealed that kangaroo care decreased pain responses in preterm infants.

ASSESSING THE NEWBORN

 

ASSESSING THE NEWBORN

Almost immediately after birth, after the baby and its parents have been introduced, a newborn is taken to be weighed, cleaned up, and tested for signs of developmental problems that might require urgent attention (Therrell & others, 2010). The Apgar Scale is widely used to assess the health of newborns at one and five minutes after birth. The Apgar Scale evaluates an infant’s heart rate, respiratory effort, muscle tone, body color, and reflex irritability. An obstetrician or a nurse does the evaluation and gives the newborn a score, or reading, of 0, 1, or 2 on each of these five health signs (see Figure 3.6). A total score of 7 to 10 indicates that the newborn’s condition is good. A score of 5 indicates there may be developmental difficulties. A score of 3 or below signals an emergency and indicates that the baby might not survive.

 

The Apgar Scale is especially good at assessing the newborn's ability to respond to the stress of delivery and the new environment (Reynolds, 2010). It also identifies high-risk infants who need resuscitation. For a more thorough assessment of the newborn, the Brazelton Neonatal Behavioral Assessment Scale or the Neonatal Intensive Care Unit Network Neurobehavioral Scale may be used.

The Brazelton Neonatal Behavioral Assessment Scale (NBAS) is typically performed within 24 to 36 hours after birth. It is also used as a sensitive index of neurological competence up to one month after birth for typical infants and as a measure in many studies of infant development (Mamtani, Patel, & Kulkarni, 2008). The NBAS assesses the newborn's neurological development, reflexes, and reactions to people and objects. Sixteen reflexes, such as sneezing, blinking, and rooting, are assessed, along with reactions to animate (such as a face and voice) and inanimate stimuli (such as a rattle).

An "offspring" of the NBAS, the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) provides another assessment of the newborn's behavior, neurological and stress responses, and regulatory capacities (Brazelton, 2004; Lester, Tronick, & Brazelton, 2004). Whereas the NBAS was developed to assess normal, healthy, term infants, T. Berry Brazelton, along with Barry Lester and Edward Tronick, developed the NNNS to assess the "at-risk" infant. It is especially useful for evaluating preterm infants (although it may not be appropriate for those less than 30 weeks’ gestational age) and substance-exposed infants (Boukydis & Lester, 2008). A recent NNNS assessment (at one month of age) of preterm infants who were exposed to substance abuse prenatally revealed that the NNNS predicted certain developmental outcomes, such as neurological difficulties, IQ, and school readiness at 4.5 years of age (Liu & others, 2010).

BIRTH PROCESS, Birth

 

Birth

Nature writes the basic script for how birth occurs, but parents make important choices about conditions surrounding birth. We look first at the sequence of physical steps when a child is born.

THE BIRTH PROCESS

The birth process occurs in stages, occurs in different contexts, and in most cases involves one or more attendants.

Stages of Birth

The birth process occurs in three stages. The first stage is the longest of the three stages. Uterine contractions are 15 to 20 minutes apart at the beginning and last up to a minute. These contractions cause the woman’s cervix to stretch and open. As the first stage progresses, the contractions come closer together, appearing every two to five minutes. Their intensity increases. By the end of the first birth stage, contractions dilate the cervix to an opening of about 10 centimeters (4 inches), so that the baby can move from the uterus to the birth canal. For a woman having her first child, the first stage lasts an average of 6 to 12 hours; for subsequent children, this stage typically is much shorter.

The second birth stage begins when the baby’s head starts to move through the cervix and the birth canal. It terminates when the baby completely emerges from the mother’s body. With each contraction, the mother bears down hard to push the baby out of her body. By the time the baby’s head is out of the mother’s body, the contractions come almost every minute and last for about a minute. This stage typically lasts approximately 45 minutes to an hour.

Afterbirth is the third stage, at which time the placenta, umbilical cord, and other membranes are detached and expelled. This final stage is the shortest of the three birth stages, lasting only minutes.

Childbirth Setting and Attendants

In the United States, 99 percent of births take place in hospitals, a figure that has remained constant for several decades (Martin & others, 2005). Who helps a mother during birth varies across cultures. In U.S. hospitals, it has become the norm for fathers or birth coaches to be with the mother throughout labor and delivery. In the East African Nigoni culture, men are completely excluded from the childbirth process. When a woman is ready to give birth, female relatives move into the woman’s hut and the husband leaves, taking his belongings (clothes, tools, weapons, and so on) with him. He is not permitted to return until after the baby is born. In some cultures, childbirth is an open, community affair. For example, in the Pukapukan culture in the Pacific Islands, women give birth in a shelter that is open for villagers to observe.

Midwives

Midwifery is practiced in most countries throughout the world (Wickham, 2009). In Holland, more than 40 percent of babies are delivered by midwives rather than doctors. However, in 2003, 91 percent of U.S. births were attended by physicians, and only 8 percent of women who delivered babies were attended by a midwife (Martin & others, 2005). Nonetheless, the 8 percent figure in 2003 represents a substantial increase from less than 1 percent of U.S. women attended by a midwife in 1975 (Martin & others, 2005). Ninety-five percent of the midwives who delivered babies in the United States in 2003 were certified nurse-midwives.

Doulas

In some countries, a doula attends a childbearing woman. Doula is a Greek word that means “a woman who helps.” A doula is a caregiver who provides continuous physical, emotional, and educational support for the mother before, during, and after childbirth. Doulas remain with the parents throughout labor, assessing and responding to the mother’s needs. Researchers have found positive effects when a doula is present at the birth of a child (Berghella, Baxter, & Chauhan, 2008).

In the United States, most doulas work as independent providers hired by the expectant parents. Doulas typically function as part of a “birthing team,” serving as an adjunct to the midwife or the hospital’s obstetric staff.

Methods of Childbirth

U.S. hospitals often allow the mother and her obstetrician a range of options regarding their method of delivery. Key choices involve the use of medication, whether to use any of a number of nonmedicated techniques to reduce pain, and when to have a cesarean delivery.

Medication

Three basic kinds of drugs that are used for labor are analgesia, anesthesia, and oxytocin/pitocin.

Analgesia is used to relieve pain. Analgesics include tranquilizers, barbiturates, and narcotics (such as Demerol).

Anesthesia is used in late first-stage labor and during delivery to block sensation in an area of the body or to block consciousness. There is a trend toward not using general anesthesia, which blocks consciousness, in normal births because general anesthesia can be transmitted through the placenta to the fetus (Lieberman & others, 2005). An epidural block is regional anesthesia that numbs the woman’s body from the waist down. Researchers are continuing to explore safer drug mixtures for use at lower doses to improve the effectiveness and safety of epidural anesthesia (Balaji, Dhillon, & Russell, 2009).

Oxytocin is a synthetic hormone that is used to stimulate contractions; pitocin is the most widely used oxytocin. The benefits and risks of oxytocin as a part of childbirth continues to be debated (Vasdev, 2008).

Predicting how a drug will affect an individual woman and her fetus is difficult (Lowdermilk, Perry, & Cashion, 2011). A particular drug might have only a minimal effect on one fetus yet have a much stronger effect on another. The drug’s dosage also is a factor (Weiner & Buhimschi, 2009). Stronger doses of tranquilizers and narcotics given to decrease the mother’s pain potentially have a more negative effect on the fetus than mild doses. It is important for the mother to assess her level of pain and have a voice in the decision of whether she should receive medication.

Natural and Prepared Childbirth

For a brief time not long ago, the idea of avoiding all medication during childbirth gained favor in the United States. Instead, many women chose to reduce the pain of childbirth through techniques known as natural childbirth and prepared childbirth. Today, at least some medication is used in the typical childbirth, but elements of natural childbirth and prepared childbirth remain popular (Oates & Abraham, 2010).

Natural childbirth is the method that aims to reduce the mother’s pain by decreasing her fear through education about childbirth and by teaching her and her partner to use breathing methods and relaxation techniques during delivery.

French obstetrician Ferdinand Lamaze developed a method similar to natural childbirth that is known as prepared childbirth, or the Lamaze method. It includes a special breathing technique to control pushing in the final stages of labor, as well as more detailed education about anatomy and physiology. The Lamaze method has become very popular in the United States. The pregnant woman’s partner usually serves as a coach, who attends childbirth classes with her and helps her with her breathing and relaxation during delivery.

In sum, proponents of current prepared childbirth methods conclude that when information and support are provided, women know how to give birth.

Cesarean Delivery

Normally, the baby’s head comes through the vagina first. But if the baby is in a breech position, the baby’s buttocks are the first part to emerge from the vagina. In 1 of every 25 deliveries, the baby’s head is still in the uterus when the rest of the body is out. Breech births can cause respiratory problems. As a result, if the baby is in a breech position, a surgical procedure known as a cesarean section, or a cesarean delivery, is usually performed. In a cesarean delivery, the baby is removed from the mother’s uterus through an incision made in her abdomen (Lee, El-Sayed, & Gould, 2008). The benefits and risks of cesarean sections continue to be debated (Bangdiwala & others, 2010).