Chapter 3B - Birth Flashcards
NEWBORN ASSESSMENT SCALES
Almost immediately after birth, a newborn is taken to be weighed, cleaned up, and tested for signs of developmental problems that might require urgent attention - assessment scales of overall health are used:
1) The APGAR scale is widely used to assess the health of newborns at 1 and 5 minutes after birth - it evaluates infants’ Appearance, Pulse, Grimace (reflexivity), Activity and Respiration. The 1 minute score usually indicate how well the baby tolerated DELIVERY, whereas the 5 minute score indicate her ADAPTATION to the new environment.
0-2 scores are low, 3-7 are average and 8-10 are good.
2) The BRAZELTON NEONATAL BEHAVIORAL ASSESSMENT SCALE (NBAS) evaluates neurological development, reflexes, and reactions to people - it is usually performed within 36 hours from birth. The newborn is rated on four categories: physiological, motoric, state, and interaction.
PRETERM and LOW BODY WEIGTH INFANTS
- PRETERM infants are those born before the completion of 37 weeks of gestation;
- VERY PRETERM infants are those born before the completion of 33 weeks of gestation;
- EXTREMELY PRETERM infants are those born before the completion of 28 weeks of gestation.
Preterm births have been showing a steady increase in the last decades, probably due to the increase of births to women 35 years and older, of rates of multiple births, of substance abuse, and of stress.
- LOW BODY WEIGTH infants weigh less than 2.5 kg;
- VERY LOW BODY WEIGTH infants weigh less than 1.5 kg;
- EXTREMELY LOW BODY WEIGTH infants weigh less than 1 kg.
The incidence of low birth weight varies considerably from country to country. Children born at low birth weights are more likely than their normal birth weight counterparts to develop a learning disability, attention deficit hyperactivity disorder, or breathing problem such as asthma.
SPECIAL CARE for PRETERM and LOW BODY WEIGTH INFANTS
Two increasingly used interventions in the neonatal intensive care unit are:
1) KANGAROO THERAPY, which involves skin-to-skin contact in which the baby, wearing only a diaper, is held upright against the parent’s bare chest - it is typically practiced for two to three hours per day. Preterm infants often have difficulty coordinating their breathing and heart rate, and the close physical contact with the parent provided by kangaroo care can help to stabilise the preterm infant’s heartbeat, temperature, and breathing.
2) MASSAGE THERAPY, in which touch and massage are used to improve the growth, health, and well-being of infants. Massage therapy has been found to be significantly useful in reducing stress behaviours and promoting weight gain in low birth weight infants. Infants are not the only ones who may benefit from massage therapy - women in labor pain, children who have asthma, ADS children and ADHD adolescents have benefited from this therapy.
The POSTPARTUM PERIOD
The POSTPARTUM PERIOD is the period after childbirth or delivery that lasts for about six weeks or until the mother’s body has completed its readjustment - the adjustments needed are:
1) PHYSICAL: after delivery, a mother’s body undergoes sudden and dramatic changes in hormone production - especially estrogens production, which drops. Loss of sleep due to caregiving, combined with taxing physical adjustments might lead to fatigue - postpartum 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. These maladjustments can lead to stress, marital conflict, and impaired decision making.
2) PSYCHOLOGICAL: emotional fluctuations are common for mothers in the postpartum period - about 70 percent of new mothers have what are called the POSTPARTUM BLUES, feelings of depression and anxiety, often peaking about three to five days after birth that disappear without treatment. Some women develop POSTPARTUM DEPRESSION, or major depressive episodes characterised by strong feelings of despair that can make coping with daily tasks and caregiving challenging. Effective therapies include psychotherapy and antidepressants, although it is not yet clear if these are safe to take while breastfeeding. The father’s support and caring can play a role in whether the mother develops postpartum depression.
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. Some scholars believe that bonding during the first days of life is essential for optimal development, but research shows that 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 true.
Many hospitals now offer a rooming-in arrangement, in which the baby remains in the mother’s room, but research suggests that the choice not to use this arrangement will not harm the infant.
