The Beginning of Life: Pregnancy Through Preschool

Chapter 1 The Beginning of Life: Pregnancy Through Preschool I. CHILDBIRTH AND THE POSTPARTUM PERIOD A. Birth rate and cesarean birth 1. About 4 million children are born each year in the United States; 23% of all births are by cesarean section. 2. The number of cesarean births declined from 1989 to 1996, partly in response to increasing evidence that women often undergo unnecessary surgical procedures. Since 1996 the rate has been rising and is now as high as it was in 1989. B. Premature birth 1. Premature births and very premature births are defined as those following a gestation of less than 37 and 32 completed weeks, respectively. 2. Premature birth puts a child at greater risk for dying in the first year of life and for emotional, behavioral, and learning problems; physical disability; and mental retardation. 3. Premature births, which are associated with low income, maternal illness or malnutrition, and young maternal age, occur in 6% of births to white women and 13% of births to African American women. 4. The Apgar score (named for Dr. Virginia Apgar but useful as a mnemonic): A—appearance (color), P—pulse (heartbeat), G—grimace (reflex irritability), A—activity (muscle tone), R—(respiration) measures physical functioning in premature and full-term newborns ( Table 1-1) and can be used to predict the likelihood of immediate survival. P.2 TABLE 1-1 The Apgar Scoring System Measure 0 Absent Absent Flaccid, limp Both body and extremities pale or blue 1 Score Slow (< 100/min) Irregular, slow Weak, inactive Pink body, blue extremities 2 Heartbeat Rapid (> 100/min) Respiration Good, crying Muscle tone Strong, active Color of body and extremities Pink body, pink extremities The infant is evaluated 1 minute and 5 (or 10) minutes after birth. Each of the five measures can have a score of 0 , 1, or 2 (highest score = 10). Score > 7 = no imminent survival threat; score < 4 = imminent survival threat. C. Infant mortality 1. Low socioeconomic status, which is related in part to ethnicity, is associated with prematurity and high infant mortality ( Table 1-2). 2. In part because the United States does not have a system of health care for all citizens paid for by the government through taxes, prematurity and infant mortality rates in the United States are high compared with rates in other developed countries (Figure 1-1). D. Postpartum maternal reactions 1. Baby blues a. Many women experience a normal emotional reaction called " baby blues" or " postpartum blues" lasting up to 2 weeks