Unit 3.2: Birth Flashcards
What’s the perinatal environment?
environment surrounding birth
-> influences like medications, delivery practices and social environment
Why is the perinatal environment important?
because it can affect the baby’s well-being and future development
When does birth begin?
around 266 days (36 weeks/9.5 months)
Which protein released by the placenta triggers the release of hormones that initiate birth?
corticotropin-releasing hormone
What’s a hormone that initiates birth?
oxytocin
What happens during the first stage of pregnancy?
Uterus contractions every 8-10mins with contractions lasting ~30s
as labour proceeds: greater frequency and durations
-> end: contractions every 2 mins lasting 2 mins
Uterus forces head of fetus against cervix
ends when cervix is fully dilated (10 cm)
What is transition?
the period at the end of the 1st stage of birth
-> contractions with greatest intensity
What happens during the second stage of birth and when does it start?
when baby’s head passes through cervix and emerges from vaginal opening
lasts between 30-90 mins
ends when baby completely exited body
What is an episotomy?
incision into vaginal opening that is sometimes made to facilitate birth
What happens during the 3rd stage of birth?
umbilical cord and placenta expelled from mother
quickest stage (usually only a few mins)
How long does it take for the average baby to be born?
first-born: 12h of active labour
second-born: 7h
Which position are most baby’s in at the end of pregnancy?
head-down postition
What’s a breech position and what are potential risks?
feet or bottom first
umbilical cord may get tangled and squeezed
-> may cause anoxia (oxygen deprivation)
-> may lead to brain damage
How are fetuses in a breech position delivered if possible?
cesarean section
What are some factors that may complicate birth?
abnormal position of fetus
intraamniotic infection
shoulder dystocia
umbilical cord prolapse
uterine inversion
etc.
Intraamniotic infection
infection and inflammation of tissue around fetus
shoulder dystocia
shoulder gets stuck at pubic bone
umbilical cord prolapse
umbilical cord comes out before the baby
Whats the difference between anoxia and hypoxia?
anoxia: oxygen level at 0
hypoxia: oxygen level alarmingly low (2-3 mg)
Why does a newborns skin turn from blue to pink?
due to blood reoxygenating after brief deprivation during birth
What happens immediately after birth?
baby cleaned and mucus removed from throat
eyes open, muscles in fingers and toes contract and relax
umbilical cord cut (apart from few centimeters)
Why is the baby’s head often misshapen (cone-shape)?
due to passage through birth canal
What’s the colostrum?
thick, nutrient rich fluid loaded with immune, growth and repair factors
Why are the first 60 minutes after birth known as the golden hour?
can maximize bond between mother and child
skin-to-skin contact, breatfeeding, etc.
What’s the optimal weight range for newborns?
3-5 kg
Why is birth weight a key factor in postnatal survival?
may be associated with underdeveloped vital organs
What effect does pre-term birth usually have on the child?
low birth weight
baby being small-for-gestational age
What’s the apgar scale?
a rating scale that evaluates 5 vital signs:
colour, heart rate, cry, muscle tone and breathing
How does the apgar scale work?
evaluation1 and 5 minutes after birth
each vital sign gets score from 0 to 2
Score of >7 healthy, <7 emergency assistance
Colour
cyanosis due to lack of oxygen in blood
skin turning pink with adequate levels
Heart rate
> 100 bpm healthy for neonate
Reflex irritability/ cry
baby responds when oropharynx (throat behind mouth) and nasopharynx (throat behind nasal cavitiy) are suctioned
Muscle tone
degree to which baby shows active motion of arms, legs and body
Respiratory effort/ breathing
degree to which baby is breathing and crying
Why should the neurological condition of the infant be assessed after birth?
to detect injury or abnormal NS development
-> provide interventions
especially important in at-risk babies
What are examples of neurological assessments in newborns?
Brazelton Neonatal Behavioural Assessment Scale (NBAS)
Prechtl’s asssessment of General Movements
How does the NBAS work?
administered during first two days after birth
lasts 30 mins
measures 20 inborn reflexes and 26 behaviours across 4 broad categories
What are the behavioural categories of the NBAS?
interaction with others
Motor behaviours
Physiological control
Physiological response to stress
Why can the NBAS be valuable to parents apart from the neurological assessment it provides?
found to improve early parent-child connection
-> parents learn about baby’s abilities and behaviours it finds relaxing
How does Prechtl’s Assessment of General Movements work?
assesses functionality of NS to detect symptoms of cerebral palsy
infants placed in supine (face up) position and assessed for general movement patters for 1-3 minutes
-> NS impaired: general movements lose complexicity and variability
What’s cerebral palsy?
brain damage affecting movement abilities
What are two abnormal general movement patterns that reliably predict cerebral palsy?
persistent pattern of “cramp-synchronised” general movements (rigid, not smooth)
absence of “fidgety” general movements
interoceptive orientation
orientation towards own bodily sensations
self-centred activity
What are states the newborn needs to acquire to survive?
breathe immediately
control temperature quickly (takes a few days to establish control)
sleep (16-20h a day, cycles of 3-4 hours of sleep and 20 mins feeding)
-> differentiation between: deep sleep, light sleep, drowsiness, alert activity, alert inactivity and crying
Which systems for transmitting information does a newborn use?
crying: reflex response to state of discomfort
-> types: basic, anger, pain, attention/frustration
emotions: subjective reactions to experience associated with physiological and behavioural changes
-> protective function
Which emotions appear in the first months?
basic emotions:
joy
sadness
anger
fear
surprise
disgust
dislike
interest
What are inborn reflexes?
series of behaviours present from birth
involuntary, automatic responses to stimuli
-> positive effect on caregivers
survival reflexes
have adaptive value
primitive reflexes
remnants of evolutionary history
-> normally disappear during first few months of life
-> maturation of cerebral cortex allows them to be over-ridden
Is the dissapearance of reflexes a bad sign?
no, it can be a sign of healthy development of the NS
Breathing reflex
repetitive inhalation and exhalation
begins beofre umbilical cord is cut
related:
sneezes (remove irritation in nose)
hiccups
sucking reflex
sucking objects placed in mouth
facilitates consumption of nutrients
related:
swallowing and spitting up reflex
rooting reflex (turning head to direction of stimulus touching cheek)
Palpebral reflex
eyeblink reflex
protects eyes from bright lights or foreign objects
related:
puppilary light reflex
babinski reflex
fanning of toes when bottom of foot is stroked
disappears withing 8-12 months
-> pyramidal tract develops and over-rides reflex to toes moving into opposite direction
stepping reflex
infants held upright with feet touching flat surface will step as if they walk
disappears during 8 weeks unless it’s practiced
Swimming reflex
when newborns are held horizontally on stomach, they stretch out arms and legs as if swimming
-> also happens when placed in water with involuntarily holding breath
disappears within 4-6 months
palmar/plantar grasp reflex
curling finger around objects that touch palm of hands
disappears during 3-4 months
very stong for their weight
moro reflex
loud noise or sudden change in position of head
-> extend arms outwar, arch back and retract arms to chest
disappears after 4-6 months with exception of startle response
Swaddling
creating a womb like environment
reduces/ stops moro reflex
Asymmetrical tonic neck reflex/ magnus tonic reflex
head positioned to one side
-> arm and leg of that side extend, opposite side flex
disappears after 3-6 months
Glabellar reflex
tapping forehead between eyebrows and nose causes eyeblink
repetitive tapping should result in habituation
persistance in adults may be sign of dementia or Parkinson’s
How do neonates receive information?
sight, hearing, touch, smell, taste and vestibular sensitivity
