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NORTHEASTERN UNIVERSITY / Psychology / PSYC 3404 / When is a cesarean delivery more likely?

When is a cesarean delivery more likely?

When is a cesarean delivery more likely?

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NOTE: What about teenage mothers?




- Who are most likely to have a low-birthweight baby?




- What is the best way to soothe a crying baby?



Developmental Psychology TOPIC: Beginnings and Infancy/Toddlerhood Physical Development (TBA) I.​ The Birth Process · Stages of Childbirth (Vaginal childbirth/labor). Refer to attached Diagram 1 - First Stage…typically lasts 12 hours or more for a woman having her first child. In later births… it takes shorter time - Second StaDon't forget about the age old question of gsu math 1001
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ge…typically lasts one and a half hours or less. If longer than 2 hours…there is a problem (the babe will need help ) - Third Stage…typically lasts about 5 to 30 minutes… when the placenta and the umbilitica cord seprated - Fourth Stage…the couple of hours after delivery… - NOTE:​ Electronic fetal monitoring…mechanical mentoring device (fetal heart rate during pregnancy and delivery ) Low risk pregnancy - costly High risk - you need it Drawback - high false possibility, and restrict mom’s movement II.​ Settings, Attendants, and Methods of Delivery - Home life birth center - Most people have them in the hospital III.​ Vaginal versus Cesarean Delivery · Vaginal Delivery…delivery of a baby [non-surgical] via the vagina. · Cesarean Delivery…delivery of a baby by surgical removal from the uterus. - When is a cesarean delivery performed? - When labour is slow, when fetus is in trouble, a feet first position, a transverse position (when the fetus is laying), or the fetus has a lot of hair - When is a cesarean delivery more likely? - Birth of the first child, larger babe, or older woman ( 35 )- Cesarean deliveries in USA… - Among the highest in the world, especially 32% of Americans opt for a Cesarean deliveries - There was a decrease in the 1990s, but the number rose sharply again at 2010 IV.​ Medicated versus Un-medicated Delivery · Medicated Deliveries: - General anesthesia… - When a person completely uder ( extremely rare) - Regional/local anesthesia… - Most likely to be use - Relaxing analgesic… - They don’t do that (when you get high) NOTE:​ Do drugs pass through the placenta to enter the fetal blood supply and tissues(it does) , and thus pose danger to the baby? Highly unlikely Improvements in medicated deliveries? - Smaller amount of drug, so they wait it to open up more 2. Un-medicated Deliveries: · Natural Childbirth…preventing pain by eliminating fear through education. Also, training in breathing and relaxation during delivery. ( A focus mostly eliminating fear through education ) · Prepared Childbirth…using instruction, breathing exercises, and social support to induce control, and reduce fear and pain. (focus mostly on control on physical reactions) V.​ The Newborn Baby Note:​ Neonatal Period…first four weeks of life. · Size and Appearance: - At birth, 95 percent of full-term babies weigh between seven and a half to ten pounds and are between 18 and 20 inches long. - Boys tend to be longer and heavier than girls. - Firstborns tend to weigh less at birth than later borns. ( not backed up ) - First few days neonates will lose weight ( lose about 10 % of body weight - fluid weight) - Gaining weight again on day 5- Back to their birth weight between day 10 - 13 - New babies have distinct features (thin skin, residing chin, big ass hair) - Lanugo… ( bodily hair that babe have - but it drops off within a few day) - Vernix Caseosa…protection against infection - oil stuff that babe has but it dries off · Body Systems (Refer to Table 1) · States of Arousal (Refer to Table 2) - Seem to be inborn and highly individual”! - Newborns average about 16 hours of sleep a day. - Most wake up every two to three hours, day and night. ( hungry ) - It is important to quiet low-birthweight babies…for quiet babies maintain their weight better. ( something babe has to be hold - cuddlers ) - What is the best way to soothe a crying baby? - steady stimulation - hold it, rocking the thing, or walking ( but don’t do if don’t have to ) · As infants grow, less required sleep - 3 months… - More wakeful at late afternoon and at early night - Capable to sleep through the night - 6 months… - More than half of their sleep occurs at night - Sleep patterns as per different cultures… - Is not purely biological - Differ from culture to culture · Neonatal Reflexes: Infants are born with simple, coordinated, unlearned responses, called reflexes that provide limited ways for them to interact with their environment. Some reflexes aid survival because they orient the infant toward food or protection. Protective reflexes include coughing, sneezing, blinking, and muscle withdrawal. Feeding reflexes include the rooting and sucking reflexes. Because reflexes help a newborn survive, an assessment of reflexes provides important insight into problems that some babies may face. See attached table page, ​Some Neonatal ReflexesVI. Survival and Health · Medical and Behavioral Assessment - The Apgar Scale (refer to attached table 3​) *Assessed 1 minute after birth, then again 5 minutes later. *Max score = 10 *Score 7-10… ( good to excellent ) *Score below 7… ( help to breathing ) *Score below 4… ( need immediate life saving treatment ) ( if breathing can be store within 10 mins they will likely not to have a problem) - The Brazelton Neonatal Behavioral Assessment Scale: Used to assess neonates’ responsiveness to their physical and social environment, to identify problems in neurological functioning, and to predict future development. The test takes about 30 minutes. · Neonatal screening for Medical Conditions: - Routine screening for rare conditions! ( many of them are correctable) - “Very expensive”! ( cost effective in the long run ) - State requirements… test for PKU - that can lead to mental retard - Hypo -something - Risk in doing these tests… Can get some false positive - Screening in Massachusetts (Refer to attached handout​)   VI.​ Complications of Childbirth:    · Birth Trauma…injury sustained at the time of birth. Reasons? - Because of some types of diease or infection· Postmaturity…A pregnant woman who has not gone into labor two weeks after the due date, or forty-two weeks after last menstrual period. - Postmature babies… usually long and thin, grow in a every aged placenta - Delivery of a postmature baby… Often time induce with drug, and via Cesarean delivery · Prematurity and Low Birthweight: Second leading cause for fetus death - Low Birthweight…less than five and a half pounds at birth because of prematurity or being small for date. - Very low-birthweight… less than 3.5 pounds - Premature (preterm) Infants…born before completing the 37th week of gestation. ( may or not be appropriate size) - Small-for-date (small-for-gestational age) infants…birthweight is less than that of 90 percent of babies of the same gestational age, as a result of slow fetal growth. These babe may or may not be preterm (often time cause of poor prenator care) - Successful treatment for saving low-birthweight babies in the United States… More successful than any other developed countries, but has the highest rate of low- birthweight baby - increase in the multiple birth since the 1980s - induce labor - birth to woman over 35) - Who are most likely to have a low-birthweight baby? Woman who are less than 17 or over 40, woman who has multiple miscarriages, if she was low-birthweight babe herself, if she has previous low-birth, short woman, or thin - Low-birthweight babies in the African-American population… These babies are twice likely than white and hispanic to have low-birthweight, major factor of black babies (social - economic factor) - IMMEDIATE TREATMENT AND OUTCOME Fed intravenously… becasue they dont have the stucking reflect Treated for infections… meal thing is not fully developeSusceptible to respiratory distress syndrome… Lungs… not fully developed so they have breathing tube Placed in isolette… in incubator ( protect from infection ) - LONG-TERM OUTCOMES In general, there are developmental concerns if low-birth weight babies survive the dangerous early days. Small-for-gestational age babies compared to premature (preterm) but appropriate weight babies… neurologically and cognitive impair Preterm low-birthweight babies who are in fact neurologically and cognitive impaired… they usually remain so as they grow older ( may not be extreme but is there - something the onset of the thing may not show till kindergarden ) Very low-birthweight babies have a greater chance of having longterm and more severe impairments! VII.​ Death During Infancy · Improving Infant Survival in USA, but compared to other industrialized nations… - Infant mortality rate… number of death in the first year per 1000 life death - Leading causes [in order] of death during the neonatal ( first 4 weeks) period… low- birthweight, Sudden death symdrome, maternal complication- Why do babies in the United States have a poorer chance of reaching their first birthday than do babies in many other industrialized countries? Those other countries than have free pre and post natal health care - Racial disparities in infant mortality [in the USA] have increased… black babies in generally are two times more likely to die than white and hispanic babies Black low-birthweight in general are 4 times more likely to die · Sudden Infant Death Syndrome (SIDS) - Leading cause of death in infants after the neonatal period… babe of 1- 4 months can occur to 1 year old - Most often results from a combination of factors… can be biological problem, terotadras (drinking, smoking, using drug), sleep position - Research strongly supports a relationship between SIDS and sleeping on the Stomach… is not good cuz can result in overheating, suffocation, or rebreathing - Side-sleeping is not safe either… too easy to end up on their stomach · Immunization for Better Health: “The benefits outweigh the risks”!! VIII.​ Teratogens: Any environmental agent that causes damage during the prenatal period. ​Refer to Table 4 · Harm done by them not always simple and straightforward. Depends on following factors: - Dose - larger the dose is the longer the period is and has more negative effects - Heredity - the genetic makeup of the mother, and developing organism play important factors- Other negative influences - if there is several negative factors at once can have very negative effects - Age of the organism (Refer to Figure 1) - first couple of weeks (terotegens rarely have effect ) - Embryonic stage can have serious impacts because this is when all the body parts are being lay down - Fetal period - minor damage at this time, but can still have some effect (eyes, teeth, and gential) · Specific Teratogens: - Prescription and Nonprescription Drugs: *Thalidamide and DES… - Thalidamide if take 4-6 weeks after pregnancy then the embryo has gross deformative ( legs and arms ) ( or the ears, gential, heart ) ​ ( when the kids grow older they score a lower intellegence) - DES - what they give for pill abortion ( kids have problem with fuction of penis and pussy ) *Accutane….. ( most widely used tetrogens) - works well, and lots of women use it. If they are exposed to this at the first stage then the kid is seriously screwed up ( you dont get pregnant when you use it ) - Any drug with a molecule small enough to penetrate the placenta barrier Can enter the embryonic or fetal blood supply!​ But… woman still continously use the medical without consulting doctors - Caffeine…​ is a teratogens ( one to two a day is okay ) ( late finding says that caffeine is more damaging if you are trying to get pregnant ) high dose of caffeine has low-birthweight babe  - Aspirin… ​in term of the regular use of aspirin are mixed (can lead to low-birthweight or death ) ( lower IQ score in early childhood )- Antidepressant Medication… ​Link to prematral ( birth complication - high blood pressure - both mother and the child ) - Illegal Drugs ​- 4% of US woman use ** Babies born to users…are in trouble, stress babe, problem sleeping, cry a lot ** Contradictory findings on babies prenatally exposed to cocaine… some study out there shows that there are no major negative effect on prenater effect, and some shows the opposite ** Marijuana… most widely used illegal drug ( smaller head size - major brain growth - over activity, aggressive ) - Tobacco ​- 14 % of US women smoke in pregnancy ** Smoking has declined in Western nations, but… ** Best known prenatal effect of smoking is low-birthweight! But, there are other serious consequences…. miscarriage , prematurity, cancer later in childhood, less attentive to sound, more excited when touch and visually stimulated  ** Basically, nicotine constricts blood vessels, lessen blood flow to the uterus, causes placenta to grow abnormally. As a result… reduction in the transfer of nuturtion Also, raised carbon monoxide in bloodstream… have this in the mother and the fetus bloodstream - major problem with the nevour system, and slow growth ** One-third to one-half of nonsmoking pregnant women are “Passive Smokers”… around people who smoke - Alcohol:​ Fetal Alcohol Spectrum Disorder (FASD)…encompasses a range of physical, mental, and behavioral outcomes caused by prenatal alcohol exposure. Children are given one of three diagnoses which vary in severity. See Figure 2 and Figure 2a. ** When provided with enrich diets… they still can’t catch up in physical size** Mental impairment… with three of the dyonose and is premnant ** In adolescence and early adulthood, FASD is associated with… a lot of problems ( poor school performance, law, drug, alcohols abuse, stress reaction, ** 25% of US mothers report drinking at some point in their pregnancy. Higher in poverty-stricken women! ** Even mild drinking…is not good (less than one drink a day) - result a smaller size head - child will have poor body growth - Radiation -​even low level is not good, can cause childhood cancer (japam WW2 ) - Environmental Pollution ​- pregnant women should not eat long live fish ( swordfish, shark) - Other Maternal Factors ** Nutrition ( 25 - 30 pounds) ** Emotional Stress - release stress, if across the placenta can damage the kids, and the mother ( lead to death of kid, low-birthweight) ** Rh Factor Incompatibility: When the mother is Rh-negative (lacks the Rh blood protein) and the father is Rh-positive (has the protein), the baby may inherit the father’s Rh-positive blood type. If even a little of a fetus’s Rh-positive blood crosses the placenta into the Rh-negative mother’s bloodstream, she begins to form antibodies to the foreign Rh protein. If these enter the fetus’s system, they destroy red blood cells, reducing the oxygen supply to organs and tissue. Miscarriage, mental retardation, heart damage, and infant death can occur. Intervention… revolves around it takes awhile for the mother to produce Rh antibodies therefore the first child is ratherly affected. The danger increases each additional pregnancy, but it can be prevented by after the birth of the Rh positive baby the Rh negative mother can get shoot to prevent it.** Maternal age: See Figure 3 In general… when you delay Healthy women in their 30s… about the same rate as those in their 20s Complication rate… very sharp increase among women 50 to 55 Most women who get pregnant around 50 to 55 they usually have help.  NOTE: What about teenage mothers? Does physical immaturity cause prenatal complication (no not necessary ) Because a lot of these they come from environment they are stress or poor nutrition (the difficulty is not necessary becasue of their age, but the external factors) IX.​ The Importance of Prenatal Health Care: ​See Figure 4, Figure 4a, Table 5 X.​ Body Growth: Dramatic increase in body size! (​See Figure 5) · Height - End of first year… typical infant’s height is 32 inches - By 2 years…(height) typical is around 36 inches · Weight - will double - 5 months of age… - At one year… will triple (weight )- At 2 years… *4 weight XI.​ Changes in Body Proportions · Two growth patterns: - First, Cephalocaudal trend… (head to tail) during prenatal development the head develope more rapidly than the lower part of the body At birth the head takes up ¼ of the total body, and the legs are the smaller portion ⅓ of the body length Around the age of two head takes up to ⅕ , and the legs takes up ½ - Second, Proximodistal trend… (near to far) during the prenatal development the head, chest, and trunk grow first, and then the arms and legs, last the feet and hands - During infancy and childhood, arms and legs continue to grow a little faster than the hand and the feet XII.​ Brain Development · Brain nearer to its adult size than any other physical structure, and it continues to grow at an astounding pace throughout infancy and toddlerhood! · See Figure 6 - Prefrontal Cortex: Is responsible for thought…in particular, consciousness, inhibition of impulses, integration of information, and use of memory, reasoning, planning, and problem-solving strategies. From age 2 months on… the prefrontal cortex, it starts to function more effectively, but it is still going through a lot of changes. Each hemisphere has its function, each recieve info, and only control its own side. - Lateralization of the cortex (Specialization of the two hemispheres). **Each hemisphere…**Left: Largely responsible for… **Right: Largely responsible for… **At birth, the hemispheres have already begun to specialize. When do infants show greater activation in left…and when do they show greater activation in right? With the right is speech and sound, or positive state of arousal. Left - negative emotion **Studies of deaf adults who, as infants and children, learned sign language (a special skill). Compared with hearing adults, these individuals depend more on the right hemisphere for language processing. Also, toddlers who are advanced in language development show greater left-hemispheric specialization for language than their more slowly developing agemates. NOTE: THE VERY PROCESS OF ACQUIRING LANGUAGE AND OTHER SKILLS PROMOTE LATERALIZATION! - Plasticity of the cortex (timing of brain lateralization): A highly plastic cerebral cortex, in which areas are not yet committed to specific functions, has a high capacity for learning. And if a part of the cortex is damaged, other parts can take over tasks it would have handled. But, once the hemispheres lateralize, damage to a specific region means that the abilities it controls cannot be recovered to the same extent or as easily as earlier. **The brain is more plastic during the first few years than it will ever be again! **Research on brain-damaged children and adults offers dramatic evidence for substantial plasticity in the young brain. For example, among preschoolers with brain injuries sustained in the first year of life, deficits in language and spatial abilities were milder than those observed in brain-injured adults. As the children gained perceptual, motor, and cognitive experiences, other stimulated cortical structures compensated for the damaged areas, regardless of the site of injury. But…. even thought that’s the case, these children can still have issues during the school year ( mild defecies, math,reading, because you have health regions that taking on the health region taking on the damaged region, thus they are working harder, and doing multiple tasks with a smaller volume of brain tissues) · Sensitive Periods of Development in Brain Development - Extreme sensory deprivation…Both animal and human study that extreeme deprivation and result in brain damage ) - Human evidence: Victims of Deprived Early Environments: **In one investigation, researchers followed the progress of a large sample of children transferred between birth and 3 ½ years from extremely deprived Romanian orphanages to adoptive families in Great Britain. On arrival, most were impaired in all domains of development. Cognitive Catch-up? = Impressive for children adopted before 6 months! Childhood and Adolescence… when they reach childhood and adolense they have average test score Comparison group early-adopted British born children…perform as same to the comparison group = Those institutionalized > 6 months showed serious intellectual deficits. Middle school and adolescence they have some improvement, but score below average ( also have some major mental health issue- highper active each child display at least three major problems) **Neurological findings indicate that early, prolonged institutionalization leads to a generalized decrease in activity in the cerebral cortex, especially the prefrontal cortex, which governs complex cognition and impulse control. Neural fibers connecting the prefrontal cortex with other brain structures involved in control of emotion are also reduced. And activation of the left cerebral hemisphere, governing positive emotion, is diminished relative to right cerebral activation, governing negative emotion.**Chronic stress of early, deprived orphanage rearing disrupts the brain’s capacity to manage stress, with long-term physical and psychological consequences. For example, researchers followed the development of children who had spent their first eight months or more in Romanian institutions and were then adopted into Canadian homes. Compared to agemates adopted shortly after birth… they shows extreme stress activities, and high concentration of stress, and linked to major problems that goes on in childhood - Appropriate Stimulation: **Bucharest Early Intervention Project. About 200 institutionalized Romanian babies were randomized into conditions of either care as usual or transfer to high-quality foster families between ages 5 and 30 months. Specifically trained social workers provided foster parents with counseling and support. Follow-up between 2 ½ and 4 years revealed that the foster-care group exceeded the institutional-care group in intelligence test scores, language skills, emotional responsiveness, and EEG and ERP assessments of brain activity. On all measures, the earlier the foster placement, the better the outcome. But consistent with an early sensitive period, the foster-care group remained behind never-institutionalized agemates living with Bucharest families. NOTE: What about environments that overwhelm children with expectations beyond their current capacities…would such environments interfere with the brain’s potential? (do not expose them to stuff they are not they are not ready to be exposed to - stressful for them ) NOTE: How do we characterize appropriate stimulation during the early years? Answer: By distinguishing between two types of brain development…Experience-Expectant brain growth and Experience-Dependent brain growth. Age appropriate and daily activities 1. E-ebg: Refers to the young brain’s rapidly developing organization, which depends on ordinary experiences. Opportunities to explore the environment, interact with people, and hear language and other sounds.2. E-dbg: Occurs throughout our lives. It consists of additional growth and refinement of established brain structures as a result of specific learning experiences that vary widely across individuals and cultures. XIII.​ Learning Capacities Babies learn by observing others; they can imitate the facial expressions of others. · Classical Conditioning. See Figure 7 -​ helps baby to make sense of everyday world ( it enables them to know what goes together and pair together - connection) - helps them to respond effectively · Operant Conditioning - Reinforcement and punishment… · Imitation: Copying the behavior of others. A primitive learning ability! ( widely accepted but not a lot of research to support it ) ( key way of learning ) XIV.​ Motor Development: · Gross-motor development/Fine-motor development​ (Refer to Figure 8) · Reaching and grasping. See figure 9 - Of all motor skills, GASPING/REACHING play the greatest role in infant cognitive development! - reaching plays the most important role in the toddler’s cognitive development - Start out as gross, diffused activity and move toward mastery of fine movement! - See figure 9 ( shows some milestone in the first nine months) - prereaching - rarely make contact

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