Prenatal Development, Birth, and the Newborn Baby
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Prenatal Development, Birth, and the Newborn Baby Prenatal Development Conception • Period of the Zygote • Period of the Embryo • Period of the Fetus Prenatal Environmental Influences Teratogens • Other Maternal Factors • The Importance of Prenatal Health Care Childbirth The Stages of Childbirth • The Baby's Adaptation to labor and Delivery • Assessing the Newborn's Physical Condition: The Apgar Scale Approaches to Childbirth Natural, or Prepared, Childbirth • Home Delivery Medical Interventions Fetal Monitoring • labor and Delivery Medication • Cesarean Delivery Preterm and Low-Birth-Weight Infants Preterm versus Small -for-Date Infants • Con sequences for Caregiving • Interventions for Preterm Infants 1 A Cross-National Perspective on Health Care and Other Policies for Parents and Newborn Babies Birth Complications, Parenting, and Resilience The Newborn Baby's Capacities Newborn Reflexes • Newborn States • Sensory Capacities BIOLOGY AND ENVIRONMENT The Mysterious Tragedy of Sudden Infant Death Syndrome Adjusting to the New Family Unit As these parents share an intimate moment with their children, they convey a sense of delight in their growing family and help their older daughter welcome the new baby. 60 CHAPTER 3 Prenatal Development, Birth, and the Newborn Baby 61 hen I met Yolanda and jay one fall in my child de microscopic world, it is a giant-the largest cell in the human velopment class, Yolanda was just two months body, making it a perfect target for the much smaller sperm, 1 Wpregnant. After months of wondering if the time in which measure only /soo inch. their lives was right, they had decided to have a baby. Both were full of questions: "How does the baby grow before Conception birth?" "When is each organ formed?" " Has its heart begun to About once every 28 days, in the middle of a woman's menstrual beat?" "Can it hear, feel, or sense our presence?" cycle, an ovum bursts from one of her ovaries, two walnut -sized Yolanda and Jay wanted to do organs located deep inside her abdomen, and is drawn into one everything possible to make sure of two fallopian tubes-long, thin structures that lead to the hollow, soft-lined uterus (see Figure 3.1). While the ovum is their baby would be born healthy. traveling, the spot on the ovary from which it was released, now At first, they believed that the called the corpus luteum, secretes hormones that prepare the lin uterus completely shielded the ing of the uterus to receive a fertilized ovum. If pregnancy does developing organism from any not occur, the corpus luteum shrinks, and the lining of the dangers in the environment, but uterus is discarded two weeks later with menstruation. after browsing through several The male produces sperm in vast numbers-an average of 300 million a day-in the testes, two glands located in the pregnancy books, Yolanda and jay scrotum, sacs that lie just behind the penis. Each sperm devel realized they were wrong. Yolanda ops a tail that permits it to swim long distances upstream in the started to wonder about her diet female reproductive tract, through the cervix (opening of the and whether she should keep up uterus) and into the fallopian tube, where fertilization usually her daily aerobics routine. And she takes place. The journey is difficult: Only 300 to 500 reach their asked me whether an aspirin for a headache, a glass of wine destination. Sperm live for up to six days and can lie in wait for the ovum, which survives for only one day after being released at dinner, or a few cups of coffee during study hours might into the fallopian tube. However, most conceptions result from be harmful. intercourse occurring during a three-day period-on the day of In this chapter, we answer Yolanda and Jay's questions, ovulation or during the two days preceding it (Wilcox, along with many more that scientists have asked about the Weinberg, & Baird, 1995). events before birth. First, we trace prenatal development, With conception, the story of prenatal development begins paying special attention to environmental supports for to unfold. The vast changes that take place during the 38 weeks of pregnancy are usually divided into three phases: ( 1) the healthy growth, as well as damaging influences that threaten the child's health and survival. Next, we turn to the events of childbirth, including the choices available to women in in dustrialized nations about where and how to give birth. Yolanda and Jay's son joshua was strong, alert, and healthy at birth. But the birth process does not always go smoothly. We will consider the pros and cons of medical in terventions, such as pain-relieving drugs and surgical deliver ies, designed to ease a difficult birth and protect the health of mother and baby. Our discussion also addresses the devel opment of infants born underweight or too early, before the prenatal period is complete. We conclude with the remark able capacities of newborns. ,. Prenatal Development ~t------- In this photo taken with the aid of a powerful microscope, sperm The sperm and ovum that unite to form the new have completed their journey up the female reproductive tract and are beginning to penetrate the surface of the enormous-l ooking individual are uniquely suited for the task of reproduction. ovum, the largest cell in the human body. When one sperm success 1 The ovum is a tiny sphere, measuring /175 inch in diameter fully fertilizes the ovum, the resulting zygote begins to duplicate. the size of the period at the end of this sentence. But in its 62 PART II Foundations of Development CD 0 Zygote Fallopian tube • FIGURE 3.1 • Female reproductive organs, showing fertilization, early cell Trophoblast duplication, and implantation. Soft uterine lining (From Before We Are Born, 6th ed . by K. L. Moore and T. V. N. Persaud , p. 87. Copyright © 2003, reprinted with permission from Elsevier, Inc.) CD 0 Zygote Blastocyst Implantation As the zygote moves By the fourth day it forms a hollow, At the end of the first week, down the fallopian tube, fluid-filled ball , called a blastocyst. the blastocyst begins to it duplicates, at first slowly The inner cells, called the embryonic implant in the uterine lining. and then more rapidly. disk, will become the new organism. The outer cells, or trophoblast, will provide protective covering. period of the zygote, (2) the period of the embryo, and (3) the As many as 30 percent of zygotes do not survive these first period of the fetus. As we consider each, refer to Table 3.1, two weeks. In some, the sperm and ovum do not join properly. which summarizes milestones of prenatal development. In others, cell duplication never begins. By preventing implan tation in these cases, nature eliminates most prenatal abnor Period of the Zygote malities (Sadler, 2006). The period of the zygote lasts about two weeks, from fertiliza tion until the tiny mass of cells drifts down and out of the fal lopian tube and attaches itself to the wall of the uterus. The zygote's first cell duplication is long and drawn out; it is not complete until about 30 hours after conception. Gradually, new cells are added at a faster rate. By the fourth day, 60 to 70 cells exist that form a hollow, fluid-filled ball called a blastocyst (refer again to Figure 3.1) . The cells on the inside, called the embryonic disk, will become the new organism; the outer ring of cells, termed the trophoblast, will become the structures that provide protective covering and nourishment. • IMPLANTATION. Between the seventh and ninth days, implantation occurs: The blastocyst burrows deep into the uterine lining. Surrounded by the woman's nourishing blood, it starts to grow in earnest. At first, the trophoblast (protective outer layer) multiplies fastest. It forms a membrane, called the amnion, that encloses the developing organism in amniotic fluid, which helps keep the temperature of the prenatal world Period of the zygote: seventh to ninth day. The fertilized ovum constant and provides a cushion against any jolts caused by the duplicates rapidly, forming a hollow ball of cells, or bla stocyst, by woman's movements. A yolk sac emerges that produces blood th e fourth day after fertilization. Here the blastocyst, magnified thousands of times, burrows into the uterine lining between the cells until the liver, spleen, and bone marrow are mature seve nth and ninth day. enough to take over this function (Moore & Persaud, 2008 ). CHAPTER 3 Prenatal Development, Birth, and the Newborn Baby 63 • TABLE 3.1 • Milestones of Prenatal Development TRIMESTER PERIOD WEEKS LENGTH AND WEIGHT MAJOR EVENTS First Zygote The one-celled zygote multiplies and forms a blastocyst. 2 The blastocyst burrows into the uterine lining. Structures that feed and protect the developing organism begin to form amnion, chorion, yolk sac, placenta, and umbilical cord. Embryo 3-4 Xinch (6 mm) A primitive brain and spinal cord appear. Heart, muscles, ribs, backbone, and digestive tract begin to develop. 5-8 1 inch (2.5 em); Ji ounce Many external body structures (face, arms, legs, toes, fingers) (4 g) and internal organs form. The sense of touch begins to develop, and the embryo can move. Fetus 9-12 3 inches (7 .6 em); less Rapid increase in size begins. Nervous system, organs, and than 1 ounce (28 g) muscles become organized and connected, and new behavioral capacities (kicking, thumb sucking, mouth opening, and rehearsal of breathing) appear. External genitals are well formed , and the fetus's sex is evident. Second 13-24 12 inches (30 em); 1.8 The fetus continues to enlarge rapidly. In the middle of this pounds (820 g) period , fetal movements can be felt by the mother.