Chapter 4
Prenatal Development and Birth
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Prenatal Development
and Birth
Prenatal
Development
Birth
©2005 McGraw-Hill Ryerson Ltd.
The Postpartum
Period
Prenatal Development
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The Course of Prenatal
Development
• The Germinal Period
• The Embryonic
Period
• The Fetal Period
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The Germinal Period
• It is the period that occurs the first 2 weeks after
conception.
• By about 1 week after conception, the zygote is
composed of 100 to 150 cells.
• This period includes the creation of the zygote,
continued cell division, an attachment of the
zygote to the uterine wall.
• Implantation, or attachment to the uterine wall,
occurs about 10 days after conception.
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The Differentiation of Cells
• The Blastocyst – the inner layer of cells
that develops during the germinal period
and later becomes the embryo
• The Trophoblast – the outer layer of the
cells that develops during the germinal
period and later provides nutrition and
support for the embryo
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The Embryonic Period
• The period that occurs from 2 to 8 weeks
after conception
• The rate of cell differentiation intensifies,
support systems for the cells form, and
organs appear
• The name of the mass of cells now
changes from zygote to embryo
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Cell Layers of the Embryo
• Endoderm – inner layer; develops into the
digestive and respiratory systems
• Ectoderm – outermost layer; becomes the
nervous system, sensory receptors (ears,
nose, eyes), and skin parts (hair and nails)
• Mesoderm – middle layer; becomes the
circulatory system, bones, muscles,
excretory system, and reproductive
system
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Prenatal Life-Support Systems
• The Placenta – consists of a disk-shaped group
of tissues in which small blood vessels from the
mother of the offspring intertwine but do not join
– Very small molecules (oxygen, water, salt, food from
mother’s blood, carbon dioxide) pass back and for the
between mother and infant
• The Umbilical Cord – contains two arteries and
one vein and connects the baby to the placenta
• The Amnion – a bag or envelope that contains
a clear fluid in which the developing embryo
floats
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Important Embryonic
Developments
•
•
•
•
Third Week – neural tube develops
21 days – eyes begin to appear
24 days – heart cells begin to differentiate
Fourth Week – first appearance of the urogenital
system, arm and leg buds appear, chambers of
the heart take shape, blood vessels surface
• Fifth to Eight Week – arms and legs differentiate
further, face starts to form, intestinal track
develops, facial structures fuse
• 8 Weeks – organisms weighs 1/30 ounce and is
1 inch long
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Definition of Organogenesis
• The process of organ formation that takes
place during the first 2 months of prenatal
development
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The Fetal Period
• The period begins 2 months after conception
and lasts, on average, 7 months
• Significant time period:
–
–
–
–
–
–
Three months after conception
The end of the fourth month
The end of the fifth month
The end of the sixth month
The end of the seventh month
The eighth and ninth months
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The End of the Fourth Month
• The fetus is 6 in. long and weighs 4–7 oz.
• A growth spurt occurs in the body’s lower
parts
• Prenatal reflexes are stronger
• Arm and leg movements can be felt by the
mother for the first time
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The End of the Fifth Month
• The fetus is 12 in. long and weighs close
to 1 lb.
• Structures of the skin have formed (such
as toe and fingernails)
• The fetus is more active and shows a
preference for a particular position in the
womb
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The End of the Sixth Month
• The fetus is approximately 14 in. long and
weighs about 2 lbs.
• The eyes and eyelids are completely
formed
• A fine layer of hair covers the head
• A grasping reflex is present
• Irregular breathing movements occur
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The End of the Seventh Month
• The fetus is 16 in.
long and weighs 3
lbs.
• The fetus is adding
body fat
• The fetus is very
active
• Basic breathing
begins
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The Eighth and Ninth Months
• The fetus grows longer and gains
substantial weight, about another 4 lbs.
• Fatty tissues develop, and the functioning
of organ systems, such as heart and
kidneys, increases
• At birth, the average North American baby
is about 20 in. long and weighs 7 lbs.
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Cultural Beliefs about Pregnancy
• Specific actions in pregnancy are often
determined by cultural beliefs.
• Two fundamental views of pregnancy:
– Pregnancy is a medical condition.
– Pregnancy is a natural occurrence.
• It is important for health-care providers to
become aware of health practices of various
cultural groups, along with their health beliefs
about pregnancy and prenatal development.
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Exploring Teratology
• Teratology – the field of study that investigates the
causes of birth defects.
• Teratogen – any agent that causes a birth defect.
• Numerous teratogens exist, thus almost every fetus is
exposed to at least some.
• Specific teratogens do not usually cause a specific birth
defect.
• It may take a long time for the effects of a teratogen to
show up.
• Only about half of all potential effects appear at birth.
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Prenatal Sensitivity to
Teratogens
• Sensitivity during
Organogenesis
• Sensitivity during the
Fetal Period
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Sensitivity during Organogenesis
• The probability of a structural defect is greatest
during organogenesis.
• 15–25 days after conception, the brain is most
vulnerable.
• 24–40 days after conception, the eyes are most
vulnerable.
• 20–40 days after conception, the heart is most
vulnerable.
• 24–36 days after conception, the legs are most
vulnerable.
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Sensitivity during the Fetal
Period
• Exposure is less likely to cause anatomical
defects.
• Exposure is more likely to stunt growth.
• Exposure to more likely to create problems
in organ functioning.
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Prescription and Nonprescription
Drugs
• Both can have possible effects on the fetus.
• A tragic example is with the tranquilizer
thalidomide, prescribed in the early 1960s.
– Clearly demonstrated the varying periods of
sensitivity to teratogens through differing outcomes
based on when mothers used the drug.
• Mothers do not have to be chronic drug users for
the fetus to be harmed.
• Taking the wrong drug at the wrong time is
enough to physically handicap offspring for life.
©2005 McGraw-Hill Ryerson Ltd.
Prescription Drugs that Can
Function as Teratogens
• Antibiotics
(streptomycin,
tetracycline)
• Some depressants
• Certain hormones
(progestin, synthetic
estrogen)
• Accutane
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Nonprescription Drugs that Can
Function as Teratogens
• Diet Pills
• Aspirin
• Caffeine
– A small increase in the risks for spontaneous abortion
and low birthweight occurs for pregnant women
consuming >150 mg caffeine per day.
– No effects were found for pregnant women who drank
decaffeinated coffee.
– FDA recommends either no caffeine or very little.
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Psychoactive Drugs
• Alcohol
• Nicotine
• Illegal Drugs
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Alcohol
• Heavy drinking
• Moderate drinking
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Heavy Drinking during Pregnancy
• Fetal Alcohol Spectrum Disorder (FASD) – the term used
to refer to a broad category of disabilities and diagnoses
related to prenatal exposure to alcohol.
– Includes fetal alcohol syndrome (FAS); partial FAS (pFAS), also
known as fetal alcohol effects (FAE); alcohol-related neurodevelopmental disorder (ARND); and alcohol-related birth
defects (ARBD).
– FAS is characterized by three criteria:
• Prenatal and/or postnatal growth delay
• Characteristic cranio-facial anomalies
• Central nervous system impairments
– If two of the criteria is present, the child is said to have pFAS or
FAE.
– Adults with FAS found to have a high incidence of mental
disorders, such as depression and anxiety.
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Moderate Drinking during
Pregnancy
• “Moderate” is defined as 1 to 2 drinks a
day.
• Infants were less attentive an alert, with
effects still present at 4 years of age.
• One recent study showed that prenatal
alcohol exposure was a better predictor of
adolescent alcohol use and its negative
consequences than was family history of
alcohol problems.
©2005 McGraw-Hill Ryerson Ltd.
Nicotine
• Fetal and neonatal deaths are higher
among smoking mothers.
• There exists a higher incidence of preterm
births and lower birthweights.
• Intervention programs designed to get
pregnant women to stop smoking can
reduce some of smoking’s negative
effects, especially in raising birthweights.
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The Research on Smoking during
Pregnancy
• Studies have shown urine samples of newborns
with smoking mothers had substantial amounts
of one of the strongest carcinogens in tobacco
smoke (NNK).
• Another study showed prenatal exposure to
nicotine was related to poorer language and
cognitive skills at 4 years of age.
• Respiratory problems and SIDS are more
common among the offspring of mothers who
smoked during pregnancy.
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Illegal Drugs
• Cocaine
• Marijuana
• Heroin
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Cocaine Use during Pregnancy
• The most consistent finding is that cocaine
exposure during prenatal development is
associated with reduced birthweight, length, and
head circumference.
• A recent study associated cocaine exposure with
impaired motor development at 2 years of age.
• Fetal cocaine exposure is also linked with
impaired information processing (poor
attentional skills through 5 years of age;
impaired processing of auditory information after
birth).
©2005 McGraw-Hill Ryerson Ltd.
Other Related Influences
• Research findings must be interpreted with
caution due to the presence of other
factors in the lives of pregnant women who
use cocaine:
– Poverty
– Malnutrition
– Other substance abuse: marijuana, alcohol,
amphetamines
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Marijuana Use during Pregnancy
• Associated with increased tremors and
startles among newborns
• Associated with poorer verbal and memory
development at 4 years of age
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Heroin Use during Pregnancy
• Young infants are addicted and show withdrawal
symptoms characteristic of opiate abstinence:
–
–
–
–
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Tremors
Irritability
Abnormal crying
Disturbed sleep
Impaired motor control
• Behavioural problems are still present at the first
birthday.
• Attention deficits may appear later in
development.
©2005 McGraw-Hill Ryerson Ltd.
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Environmental Hazards
• Radiation: nuclear environments, X-rays,
computer monitors
• Chemicals: carbon monoxide, mercury,
lead, pesticides, PCBs
• Heat: saunas, hot tubs
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Findings on Radiation Exposure
• Can cause gene
mutation
• Can cause
chromosomal
abnormalities
• X-rays can effect the
developing embryo
most during the first
several weeks after
conception
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Findings on Hazardous Chemicals
• Early exposure to lead affects children’s
mental development
• Women who ate PCB-polluted fish were
more likely to have smaller, preterm
infants who reacted slowly to stimuli
• Prenatal exposure to PCBs has also been
associated with problems in visual
discrimination an short-term memory in 4year-old children
©2005 McGraw-Hill Ryerson Ltd.
Effects of Exposure to High
Temperatures
• Prolonged exposure to heat in saunas or
hot tubs that raise the mother’s body
temperature creates a fever that
endangers the fetus.
• The high temperature may interfere with
cell division and may cause birth defects
or even fetal death.
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Other Maternal Factors
•
•
•
•
•
Infectious Diseases
Nutrition
Emotional States and Stress
Maternal Diabetes
Maternal Age
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Infectious Diseases
•
•
•
•
Rubella
Syphilis
Genital Herpes
AIDS
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Rubella
• Also known as German Measles, the greatest
damage occurs when mothers contract it in the
3rd and 4th weeks of pregnancy, although
infection during the 2nd month is also damaging.
• A rubella outbreak in the mid 1960s resulted in
30,000 prenatal and neonatal deaths.
• It also caused more than 20,000 infants to be
affected, displaying mental retardation,
blindness, deafness, and heart problems.
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Syphilis
• Syphilis is a sexually transmitted disease.
• It is more damaging in later prenatal
development, 4 months or more after
conception.
• It damages organs after they are formed,
including
– Eye lesions (which can cause blindness)
– Skin lesions
• If it is present at birth it can cause problems with
the central nervous system and gastrointestinal
tract.
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Genital Herpes
• Newborns contract the virus when they are
delivered through the birth canal of a mother
with genital herpes.
• One-third of babies delivered through an
infected birth canal die.
• One-fourth of babies delivered through an
infected birth canal become brain damaged.
• If an active case of genital herpes is detected
close to a woman’s due date, a cesarean section
can be performed to keep the newborn safe.
©2005 McGraw-Hill Ryerson Ltd.
AIDS
• AIDS is a sexually transmitted disease which destroys
the body’s immune system.
• A mother can infect her offspring in three ways:
– During gestation across the placenta.
– During delivery through contact with maternal body fluids.
– Postpartum through breast feeding.
• Babies born to infected mothers can be
– Infected and symptomatic.
– Infected but asymptomatic (with the possibility of developing
symptoms up until 15 months of age).
– Not infected at all.
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Nutrition
• A developing fetus depends completely on
its mother for nutrition, which comes from
her blood.
• Important factors of nutritional status are
– Total number of calories
– Levels of protein, vitamins, and minerals
– Folic acid
• A folic acid deficiency is linked with neural
tube defects, such as spina bifida.
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Emotional States and Stress
• Effects on Pregnancy
• Effects on Labour and Delivery
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Effects of Stress on Pregnancy
• A mother’s stress can be transmitted to the
fetus.
• When a pregnant woman experiences intense
fears, anxieties, and other emotions,
physiological changes occur:
– Respiration
– Glandular secretions, such as adrenaline
• These affect the fetus by, for example, restricting
the blood flow to the uterine are depriving the
fetus of adequate oxygen.
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Effects of Stress on Labour and
Delivery
• A mother’s emotional state during pregnancy
can influence the birth process.
• An emotionally distraught mother may have
irregular contractions and a more difficult labour.
• This can lead to irregularities in the baby’s
oxygen supply or irregularities after birth.
• Research had found that pregnant women who
are optimists have less adverse birth outcomes.
©2005 McGraw-Hill Ryerson Ltd.
Maternal Diabetes
• Diabetes is a disorder of the metabolism, which most
often is caused by the inability of the body to properly
absorb sugar and starch from the blood.
• Gestational diabetes may occur during pregnancy,
usually during the 24th week.
• To ensure a smooth pregnancy and a healthy baby,
women with diabetes must take several precautions:
– Follow an appropriate meal plan that helps to maintain normal blood
glucose levels.
– Monitor glucose levels frequently.
– Control and treating hypoglycemia.
– Add or maintain an appropriate level of physical activity.
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Maternal Age
• Adolescence
• The Thirties and Beyond
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Adolescence
• Infants born to adolescents are often premature.
• The mortality rate of infants born to adolescent
mothers is double that of infants born to mothers
in their twenties.
• May be due to
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–
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Immature reproductive systems
Poor nutrition
Lack of prenatal care
Low socio-economic status
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The Thirties and Beyond
• The risk of Down Syndrome increases
after the mother reaches age 30.
• Women have more difficulty getting
pregnant after age 30.
• As women remain active, exercise
regularly, and are careful about their
nutrition, their reproductive systems may
remain healthier at older ages.
©2005 McGraw-Hill Ryerson Ltd.
Paternal Factors
• Men’s exposure to lead, radiation, certain pesticides,
pretochemical may cause abnormalities in sperm that
lead to miscarriage or disease.
• When fathers have a diet low in vitamin C, their offspring
have a higher risk of birth defects and cancer.
• Early findings point to a connection between cocaine use
in fathers an birth defects.
• Father’s smoking during pregnancy may lead to lower
birth weight and potential for their offspring developing
cancer.
• Older fathers may place their offspring at risk for certain
birth defects, such as Down syndrome and dwarfism.
©2005 McGraw-Hill Ryerson Ltd.
Prenatal Care
• Usually involves a package of medical care services in a
defined schedule of visits
• Often includes educational, social, and nutritional
services
• Includes screening for conditions that can affect the baby
or mother
• Is extremely valuable, especially for first-time mothers
• It is very important for women in poverty because it links
them with other social services
• Can motivate women to have positive attitudes toward
pregnancy
• Not all women have access to or seek out adequate
prenatal care
©2005 McGraw-Hill Ryerson Ltd.
Positive Prenatal Development
• In most pregnancies, prenatal
development does not go awry and
development occurs along with a positive
path.
• Prospective parents should be careful to
avoid the vulnerabilities to fetal
development.
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Birth
The Birth
Process
Special
Neonatal
Considerations
Measures
of Neonatal
Health and
Responsiveness
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Exploring the Birth Process
• Stages of Birth
• The
Fetus/Newborn
Transition
• Childbirth
Strategies
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The First Stage of Birth
• This is the longest of the three stages, lasting an
average of 12–24 hours.
• Uterine contractions are 15–20 minutes apart
and last up to 1 minute.
• Contractions cause the cervix to stretch and
open.
• Contractions get closer together as the stage
progresses.
• By the end of this stage the cervix is dilated to
about 4 inches.
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The Second Stage of Birth
• This stage begins when the baby’s head starts
to move through the cervix and birth canal.
• It terminates when the baby completely emerges
from the mother’s body.
• This stage lasts about one and a half hours, and
involves the mother bearing down to push the
baby out.
• Contractions come about every minute and last
about a minute.
©2005 McGraw-Hill Ryerson Ltd.
The Third Stage of Birth
• This stage is called
“afterbirth” and lasts
only minutes.
• It involves the
detachment and
expulsion of the
placenta, umbilical
cord, and other
membranes.
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The Fetus/Newborn Transition
• Being born involves considerable stress for the baby.
• Anoxia (the condition in which the fetus/newborn has an
insufficient supply of oxygen) can cause brain damage,
and is concern if delivery takes too long.
• Large quantities of adrenaline and noradrendaline are
secreted to protect the fetus in the event of oxygen
deficiency.
• After the umbilical cord is cut, 25 million air sacs in the
lungs must fill with air.
• The newborn’s bloodstream is redirected through the
lungs and to all parts of the body.
• The baby is born with a protective covering of skin
grease, called vernix caseosa, which is cleaned off.
©2005 McGraw-Hill Ryerson Ltd.
Childbirth Strategies
• Childbirth Settings
and Attendants
• Methods of Delivery
• http://vad.mhhe.com/
provided_module.cfm
?ModuleID=216 (Birth
and the Newborn:
“Childbirth Education
Alternatives”)
©2005 McGraw-Hill Ryerson Ltd.
Childbirth Settings and Attendants
• 99% of all births in Canada take place in hospitals, and
over 90% are attended by physicians.
• Relatively new birthing rooms approximate a home
setting, yet allow for medical intervention if necessary or
desired.
• Approximately 1% of Canadian women are attended by
a midwife, most of whom are nurses who have been
specially trained in delivering babies.
• In many other countries, babies are more likely to be
born at home, and women are much more likely to
choose a midwife than a physician.
• A doula is a caregiver who provides continuous physical,
emotional, and educational support before, during, and
after birth.
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Methods of Delivery
•
•
•
•
Medicated
Natural
Prepared
Cesarean
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Medicated Childbirth
• Health practitioners recommend the least
possible medication during delivery.
• Three basic kinds of drugs used for labour:
– Analgesia: used to relieve pain (tranquilizers,
barbiturates, narcotics)
– Anesthesia: block sensation in an area of the body, or
blocks consciousness (epidural)
– Oxytocics: synthetic hormones that stimulate
contractions (Pitocin)
• Individuals differ as to how drugs affect them.
©2005 McGraw-Hill Ryerson Ltd.
Natural Childbirth
• Developed by an English obstetrician to reduce
the mother’s pain by decreasing her fear through
education about childbirth and by teaching her to
use breathing methods and relaxation
techniques during delivery.
• It considers the doctor’s relationship with the
mother as an important aspect of reducing her
perception of pain, and he or she should be
present during active labour to provide
reassurance.
©2005 McGraw-Hill Ryerson Ltd.
Prepared Childbirth
• Developed by French obstetrician Ferdinand
Lamaze and is similar to natural childbirth with
the addition of a special breathing technique to
control pushing in the final stages of labour.
• It also included a more detailed anatomy and
physiology course.
• Other prepared childbirth techniques have been
developed, combining aspects from both of
these methods and emphasizing fathers as
labour coaches.
©2005 McGraw-Hill Ryerson Ltd.
Cesarean Delivery
• The baby is removed from the mother’s uterus
through an incision made in her abdomen.
• Usually performed if the baby is in a breech
position, causing the baby’s buttocks to emerge
from the vagina first.
• Also used if:
–
–
–
–
The baby is lying crosswise in the uterus
The baby’s head is too large to fit through the pelvis
The baby develops complications
The mother is bleeding vaginally
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Special Neonatal
Considerations
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Preterm Infants and Age-Weight
Considerations
• Preterm and Low-Birthweight Infants
• Long-Term Outcomes for Low-Birthweight
Infants
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Preterm and Low-Birthweight
Infants
• A preterm infant is one who is born prior to 38
weeks after conception
• A low-birthweight infant is born after a regular
gestation period of 38–42 weeks but weighs less
than 5 ½ lbs.
• Both are considered high-risk infants.
• A short gestation period does not necessarily
harm an infant, and neurological development
continues after birth on the same timetable.
• Premature infants with a precariously low
birthweight are considered high risk.
©2005 McGraw-Hill Ryerson Ltd.
Long-Term Outcomes for LowBirthweight Infants
• Most low-birthweight infants are normal and
healthy; as a group they have more health and
developmental problems.
• The number and severity of problems increase
as birthweight decreases.
• With the improved survival rate of such infants
come increases in severe brain damage.
• Lower brain weight is associated with greater
likelihood of brain injury.
©2005 McGraw-Hill Ryerson Ltd.
Long-Term Outcomes for LowBirthweight Infants (cont’d)
• Low-birthweight infants are also more likely to
have lung or liver diseases.
• School age children who were low-birthweight
babies are more likely to have learning
disabilities, attention deficit disorder, or
breathing problems like asthma.
• Children born very low in birthweight have more
learning problems and lower levels of
achievement in reading and math than
moderately low-birthweight children.
©2005 McGraw-Hill Ryerson Ltd.
Gender Ambiguity
• Gender Ambiguity (intersexuality or
hermaphroditism) – occurs when a child is
born with both male and female features.
• Surgical procedures and treatment are
available to provide specific male or
female genitatia.
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Measures of Neonatal Health and
Responsiveness
• The Apgar Scale
• The Brazelton
Neonatal
Behavioural
Assessment Scale
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The Apgar Scale
• A method widely used to asses the health of newborns at
1 and 5 minutes after birth
• It evaluate infants’
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Heart rate
Respiratory effort
Muscle tone
Body colour
Reflex irritability
• Obstetrician or nurse assess the newborn and gives a
scale of 0, 1, or 2 on each item.
• A score of 7–10 is good, 5 indicates possible
development of difficulties, 3 or below signals an
emergency.
©2005 McGraw-Hill Ryerson Ltd.
The Brazelton Neonatal
Behavioural Assessment Scale
• Performed within 24–36 hours after birth to
evaluate neurological development, reflexes,
and reactions to people.
• The newborn is rated on each of 27 items,
contributing to four categories: physiological,
motoric, state, and interaction.
• Babies are also given global classification such
as “worrisome,” “normal,” “superior.”
• Parents are shown the importance of social
interaction with their infant and how to positively
respond to their baby.
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The Postpartum
Period
What Is the
Postpartum
Period?
Physical
Adjustments
Emotional and
Psychological
Adjustments
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Bonding
What is the Postpartum Period?
• The period after childbirth or delivery
• Woman’s body adjusts, physically and
psychologically, to the process of
childbearing.
• Last about 6 weeks; body returns to near
prepregnant state.
• Influenced by what precedes it – method
and circumstances of delivery affect speed
of readjustment
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What is Postpartum Period?
(cont’d)
• Adjustment and adaptation include:
– Learning to care for baby
– Recovering from childbirth
– Caring for baby
– Learning to feel good as a mother
– Father caring for mother
– Father learning to care for baby
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Physical Adjustments
• Involution is the process by which the uterus returns to
its prepregnant size, 5–6 weeks after birth.
• Nursing the baby helps contract the uterus rapidly.
• Menstruation begins 4–8 weeks after delivery if mother is
not breast feeding.
• Breast feeding causes delay in menstruation for several
months, but ovulation can still occur.
• Physicians usually recommend refraining from sexual
intercourse for approximately 6 weeks following birth.
• Exercise is recommended for the postpartum period, as
are relaxation techniques to relax and refresh the
mother.
©2005 McGraw-Hill Ryerson Ltd.
Emotional and Psychological
Adjustments
• Emotional fluctuations are common for the
mother in the postpartum period and can be
caused by
–
–
–
–
Hormonal change
Fatigue
Inexperience/lack of confidence with the baby
The extensive time and demands of caregiving
• Mothers may benefit from professional help in
dealing with their problems if difficulties persist.
• Fathers undergo postpartum adjustment as well,
in caregiving and with concerns that the baby
comes first and gets all the mother’s attention.
©2005 McGraw-Hill Ryerson Ltd.
Bonding
• Bonding is the occurrence of close contact,
especially physical, between parents and
newborn in the period shortly after birth.
• This is a critical time when an important
emotional attachment is formed that
provides a foundation for optimal
development in years to come.
• Research supports the importance of
bonding, but challenges the significance of
the first few days of life as a critical period.
©2005 McGraw-Hill Ryerson Ltd.
Bonding (cont’d)
• Close contact does bring tremendous
pleasure, and can set in motion a climate
for improved interaction after the mother
and infant leave the hospital.
• Many hospitals offer a “rooming in”
arrangement, in which the baby remains in
the mother’s room for most of its hospital
stay.
©2005 McGraw-Hill Ryerson Ltd.