Chapter 4: Prenatal Development and Birth

Prenatal Development

Prenatal development is divided into 3 periods and lasts approximately 266 days:

Germinal period: first 2 weeks after conception, zygote created.

Embryonic period: occurs from 2 to 8 weeks after conception.

Fetal period: begins 2 months after conception and lasts until birth.

Significant Development in the Germinal Period

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The Placenta and the Umbilical Cord

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Third trimester begins

About 14-17 inches long, weighs 2.5 to 3 pounds

About 16.5 18 inches long, weighs 4 to 5 pounds

19 inches long, weighs 6 pounds

First trimester begins

Less than 1/10th of an inch long

The Three Trimesters of Prenatal Development

To 32 wks

About 11-14 inches long, weighs 1 to 1.5 pounds About 10-12 inches long, weighs 1/2 to 1 pound

Less than 1 inch long

About 5.5 inches long, weighs about 4 ounces

About 3 inches long, weighs about 1 ounce

See Figure 4.3 in textbook for more details

Fig. 4.3

Second trimester begins

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Prenatal Development

Issue of Abortion
Beliefs

and words seasoned with love If strongly opposed, then what alternatives are you offering.

Teratogen: any agent that causes birth defects:

Drugs (prescription, nonprescription). Alcohol, tobacco. Environmental pollutants. Infectious diseases. Nutritional deficiencies. Maternal stress. Advanced age of a parent.

Severity of damage to the unborn depends on:

Dose. Time of exposure. Genetic susceptibility.

Teratogens and Timing of Their Effects on Prenatal Development

Zygote 1 2
Most serious damage from teratogens in first 2-8 wks

Embryonic period (wks) 3 4 5 6 7 8

Fetal Period (wks) 9 16 32 38

Central nervous system Heart Arms Eyes Legs Ears Teeth Period of susceptibility Palate to structural defects External genitalia
Period of susceptibility to functional defects

Fig. 4.4

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Fetal alcohol syndrome: abnormalities in newborn due to mothers heavy use of alcohol in pregnancy.
Abnormalities include:

Facial deformities.

Defective limbs, face, heart.

Most have below-average

intelligence.

Some are mentally retarded.

Moderate drinkers during pregnancy had babies who were less attentive and alert even at 4 years of age.
Maternal smoking can cause :

respiratory problems. SIDS. ADHD.

low birth weight.

Illegal drugs that harm during pregnancy: Cocaine. Marijuana. Heroin.

Incompatible blood types (Rh factor). Environmental hazards: exposure to radiation or chemicals. STDs, HIV infection, AIDS.

Fetal Alcohol Syndrome

Other Parental Factors

Maternal factors: Maternal diet and nutrition. Emotional states and stress. Maternal age. Paternal factors: Paternal exposure to teratogens including smoking. Paternal age.

Percentage of U.S. Women Using Timely Prenatal Care: 1990 to 2004 1990 2004
100 90 80 70 60 50 40 30 20 10 0

Non-Latino African White women American women

Latino women

Fig. 4.6

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Preparation for Labor & Delivery

Classes

Attitude
Plain

for pain management Natural vs Drugs

Birth

 Three

stages of birth:

Uterine contractions begin at 15 to 20 minutes apart and last 1 minute; this stage lasts an average of 12 to 24 hours.

Babys head begins to move through dilated cervix opening; this stage lasts 1.5 hour on average. Afterbirth: umbilical cord, placenta, and other membranes are detached and expelled.

Birth complications include anoxia: insufficient oxygen to brain when delivery lasts too long.
Childbirth setting:

Hospital delivery room.

Home delivery with midwife.

Doula provides continuous

physical, emotional, and educational

support for mother before, during, and after childbirth.

Methods of childbirthkey choices involve use of medication and when to have a cesarean delivery. Drugs used:

Analgesia pain relief. Anesthesia blocks sensation. Oxytocics synthetic hormones to stimulate contractions.

Natural childbirthaims to reduce pain by decreasing fear and breathing techniques (Grantley Dick-Read). Prepared childbirthLamazespecial breathing and education about anatomy and physiology.

Other non-medicated techniques to reduce pain Waterbirth

Massage Acupuncture

Hypnosis
Music therapy

Cesarean Delivery: Needs to be used if baby is in breech position or other complications. Many today are choosing cesarean delivery. Women in need of cesarean delivery are more quickly identified. Doctors may order cesarean out of caution, and to avoid lawsuit if there is a possibility of maternal or fetal distress. Today, 29.1 percent of all births are cesarean.

Measuring neonatal health and responsiveness:

Apgar Scale, used 15 minutes after birth: evaluate heart rate, body color, muscle tone, respiratory effort, and reflex irritability. Brazelton Neonatal Behavioral Assessment Scale performed within 2436 hours after birth:

27 items are organized into 4 categories physiological, motoric, state, and interaction.
Assesses newborns neurological development, reflexes, and reactions to people.

The Apgar Scale

Score Body Color Heartbeat Reflex Irritability Muscle Tone

0
Blue, pale Absent No response Limp and flaccid Breathing for no more than 1 min.

1
Body pink, extremities blue

2
Entire body pink

Slow less than Fast 100 to 140 100 beats per min. beats per min. Grimace Coughing, sneezing, crying

Respiratory Effort

Inactive, weak, Strong, active some flexion of motion extremities Irregular and slow Breathing good with normal crying

Fig. 4.7

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Causes of low birthweight: Preterm babies. Small-for-date babies. Problems in developing countries.
Possible consequences of low birthweight: Brain injuries. Lung and liver diseases. Learning disabilities. ADHD. Lower levels in reading and math achievement. Deficits are evident in adulthood.

About 50% of low-birthweight children are enrolled in special education programs. Low birthweight is linked to asthma.

Some defects can be improved with:

Early speech therapy. Intensive enrichment programs. Kangaroo care and massage therapy.

Care for preterm infants:

Kangaroo careholding preterm infant so there is always skin-toskin contact.

Massage therapyTiffany Fields research.

Weight Gain Comparison of Premature Infants Who Were Massaged with Those Not Massaged
Premature infants who were massaged Premature infants who were not massaged Infant weight
3 lb. 7 oz 3 lb. 5 oz 3 lb. 3 oz 3 lb. 1 oz 2 lb. 15 oz

8 10 12 14

Age (days)

Fig. 4.8

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The Postpartum Period

Postpartum period lasts about 6 weeks after childbirth when woman adjusts physically and psychologically back to the prepregnant state:

Influenced by preceding conditions and experiences.

Mother learns to care for the baby, feel good about herself, and those close to her. Physical: hormone changes, weight loss, return to menstruation, loss of energy or fatigue. Psychological: feelings of depression, anxiety, coping in new role, excessive worrying.

Postpartum blues: symptoms appear 2 to 3 days after delivery and subside within 1 to 2 weeks

Percentage of U.S. Women Who Experience Postpartum Blues and Postpartum Depression

70%

20%

10%

No symptoms

Postpartum depression: symptoms linger for weeks or months and interfere with daily functioning

Fig. 4.9

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A Fathers Adjustment:

Generally ignored, but fathers go through considerable adjustment. Some feel baby has replaced them in terms of mothers affection. Fathers should actively care for the baby. Parents should set aside time to be together.

Bonding (formation of emotional attachment) between infant and mother:

Usually occurs in period shortly after birth. Critical component in childs development. Isolation of premature baby and use of drugs in birth process may harm bonding process. Some experts advocate a rooming-in arrangement while mother and child are in the hospital.