Continuing the notes on Chapter 2
THE   ENVIRONMENTAL CONTEXTS FOR CHILD DEVELOPMENT (PP. 73-85)

The child’s environment consists of many influences that combine to affect the course of development: the family, it's socioeconomic status,  how the family functions, the neighborhoods, schools, and communities that affect them, and the broader cultural context in which the community is embedded.

A.    The Family: In power and breadth of influence, no context for development equals the family.

•        The family is a network of interdependent relationships in which parents and children directly affect each other. Often, the behavior of one family member helps sustain a form of interaction in another that either promotes or undermines children’s well-being. Indirectly, a third party, such as grandparents, can support or undermine family relationships.

•        The family is a dynamic, ever-changing system that can be modified by important life events. The developmental status of each family member and the historical time period also contribute to a dynamic family system.

•        Despite the family’s flexible and changing nature, parental responsiveness and reasonable demands for mature behavior are crucial features of effective parenting.

C.   Socioeconomic Status and Family Functioning :Socioeconomic status (SES) is an index of a family’s or individual’s social position and economic well-being. It combines years of education, prestige and skill of one’s job, and income.

• SES is linked to timing of parenthood and family size. SES groups also differ in child-rearing values and expectations. These differences may be attributed both to varying life conditions and to differing educational levels.

• Lower-SES parents value external characteristics (e.g. obedience and neatness) and are more restrictive in interactions with their children.

• Higher-SES parents value psychological traits (e.g. happiness and curiosity) and more often engage in verbal interaction with their children.

• SES is positively correlated with cognitive and language development and academic success.

The context of the family: how communities affect child development
Child abuse and neglect are greatest where residents describe the community as a socially isolated place to live. Family stress and child adjustment problems are reduced when family ties to the community are strong.

• Neighborhoods:

       a.  Children are better adjusted socially and emotionally when their neighborhood experiences are more varied.
b.   Available neighborhood resources have a greater impact on young people growing up in economically disadvantaged than well-to-do neighborhoods.
c.  In low-income neighborhoods, after-school programs can be substituted for a lack of resources by providing enrichment activities.
d.  In low-income areas, social ties that link families to one another and to other institutions are weak or absent. Consequently, informal social controls over young people weaken, giving rise to antisocial activities.

•   Schools:  School is a formal institution designed to transmit knowledge and skills that children need to become productive members of society.

      a.  Schools differ in the quality of their physical environments, educational philosophies, and social life.
b.  Regular contact between families and teachers supports children’s development, consistent with the mesosystem in ecological systems theory.

• Towns and cities

      a.  Small towns have fewer cultural xperiences available than cities. However, small towns offer greater community involvement and safer environments for children.
b.   Community life is especially undermined in high-rise urban housing projects.

   The Cultural Context: Cultural values and practices shape family interaction, school experiences, and community settings beyond the home.

• Independence, self-reliance, and the privacy of family life are central American values.

• America’s valuing of an autonomous family is one reason that the American public has been slow to endorse publicly supported benefits for all families, such as health insurance and high-quality child care.

• In large industrialized countries such as the United States, subcultures exist in which groups of people share beliefs and customs different from the larger culture.S

• Some cultural traditions promote extended-family households, in which a parent and child live with one or more adult relatives.

• In collectivist societies, people define themselves as part of a group and stress group over individual goals.

• In individualistic societies, people think of themselves as separate entities and are largely concerned with their own goals. The United States is more individualistic than most other industrialized nations.

Public Policies and Child Development: Public policies are laws and government programs that attempt to improve conditions for children and families by responding to current social problems.

•  Due to a complex set of political and economic forces, the United States lags behind other Western nations in developing policies that benefit children and families. These reasons include the values of self-reliance and privacy and the cost of social programs.

• Public policy fostering children’s development is justified on the grounds that they have basic rights as human beings and are the future adult members of our society.

• Many government-sponsored child and family programs are crisis oriented, and funding for these efforts has been inconsistent. However, new policy initiatives are underway to improve the status of American children.

• The National Association for the Education of Young Children (NAEYC) has taken a strong leadership role in establishing accreditation systems for preschool and day care centers.

• The Children’s Defense Fund is an influential interest group whose focus is the well­being of children

THE RELATIONSHIP BETWEEN HEREDITY AND ENVIRONMENT

Behavioral genetics is a field devoted to uncovering the contributions of nature and nurture to this great diversity in human traits and abilities. The questions are a) “How Much does genetics determine or influence development?”, and b) "how do genetic potential and environmental influence interact in shaping development?"

• Heritability estimates, obtained from kinship studies, measure the extent to which individual differences in complex traits (for example, intelligence and personality) are due to genetic factors.

• The most common kinship studies compare identical and fraternal twins. The concordance rate refers to the percentage of instances in which both twins show a trait when it is present in one pair member. For a trait to be attributed solely to heredity, the rate for identical twins would have to be 100 percent.  Concordance and adoption research suggests a strong genetic component underlying schizophrenia, depression, and criminality, although the environment is also involved.

• Concerns about the accuracy and usefulness of heritability estimates and concordance rates have been expressed. They can overestimate the impact of heredity while underestimating the importance of environment. It is difficult to generalize the twin pair study results to the general population. Although they provide useful information, they do not address the process of development and the results of such studies can be misapplied.

 How do genetic inheritance and environmental influences interact to influence development?
 Some believe that heredity and environment are intricately entwined and cannot be divided into separate influences.

• A range of reaction is a person’s unique, genetically determined response to a range of environmental conditions. This accounts for how children respond in different ways to the same environment. Unique blends of heredity and environment lead to both similarities and differences in behavior.

• Canalization is the tendency of heredity to restrict development to one or a few potential outcomes. Highly canalized traits require extreme environmental conditions to deter their genetically set outcomes. We now know that environments can also limit development.

•  The concept of genetic-environmental correlation states that our genes influence the environments to which we are exposed. In a passive correlation, a child has no control over the environment available to him or her. Parents create an environment compatible with their own heredity. In an evocative correlation, a child's behavior is consistent with his or her own heredity and the responses evoked from others will, in turn, strengthen the child’s original response. An active correlation is more common at older ages, when children begin to be able to choose environments that complement their genetic tendencies. (This tendency to actively choose environments that complement our heredity is called niche-picking.) With age, genetic factors may become more important in determining the environments we experience and choose for ourselves.

• Environmental Influences on Gene Expression: the relationship between heredity and environment is not a one-way street from genes to environment to behavior. Rather, it is bidirectional; genes affect children’s behavior and experiences, but their experiences and behavior also affect gene expression. Stimulation of both internal and external environments (of the child) triggers gene activity. Epigenesis means the development of the individual resulting from ongoing, bidirectional exchanges between heredity and all levels of environment. The success of any attempt to improve development depends on the characteristics we want to change, the genetic makeup of the child, and the type and timing of our intervention.

PRENATAL DEVELOPMENT (PP. 103-111) I will skip over the 'sex-ed' aspects of this and concentrate on the factors that influence the developing child.

Pregnancy is often discussed in terms of trimesters. Trimesters are the three equal time periods in the prenatal period, each of which lasts three months. The first trimester is the time of the most rapid growth, development and change, and the time of the greatest vulnerability during development.  It begins with conception.

1. Conception, the fertilization of the ovum by a sperm, to form a zygote, takes place in the fallopian tube .

• The period of the zygote lasts about 2 weeks, from fertilization until the cell mass drifts out of the fallopian tubes and attaches itself to the uterine wall.

• By the fourth day after conception, 60 to 70 cells exist that form a hollow, fluid-filled ball called a blastocyst. The embryonic disk (the cells on the inside) will become the new organism; the outer ring, called the trophblast,  will provide protective covering.

• Implantation occurs sometime between the seventh and ninth day when the blastocyst burrows deep into the lining of the uterus. The amnion is a membrane that encloses the developing organism in amniotic fluid. The fluid functions as a cushion and temperature regulator. The yolk sac produces blood cells until the liver, spleen, and bone marrow mature enough to take over this function. The chorion, a protective membrane, develops around the amnion by the end of the second week. The placenta is a special organ that permits food and oxygen to reach the zygote and waste products to be carried away. The umbilical cord connects the placenta to the developing organism.

• As many as 30 percent of zygotes do not make it through this critical, complex, and delicate phase; many pregnancies end before the woman ever knows she is pregnant.

2..   The Period of the Embryo:  The period of the embryo lasts from implantation through the eighth week of pregnancy. The most rapid prenatal changes take place during these six weeks as the groundwork for all body structures and internal organs is begun.

•  Last Half of the First Month (p. 107)a.  During the third week (the first week of the period of the embryo), the embryonic disk folds over to form three cell layers:  Ectoderm becomes the nervous system and skin, Mesoderm, from which will develop muscles, skeleton, circulatory system, and other internal organs, and Endoderm, which becomes the digestive system, lungs, urinary tract, and glands) 
  b.  The nervous system develops fastest in the beginning. The neural tube is a primitive spinal cord that forms when the ectoderm folds over

  The Second Month (p. 108)The rapid development of body parts and systems continues. The embryo’s posture becomes more upright. The embryo can move, and it responds to touch, especially in the mouth area and on the soles of the feet.

3.   The Period of the Fetus (pp. 108-111)  The period of the fetus, which begins with the third month after conception, is the “growth and finishing” phase that lasts until the end of pregnancy.

   The Third Month (p. 108), the last month of the first trimester:

• The organs, muscles, and nervous system start to become organized and connected.

• By the twelfth week, the external genitals are well-formed, and the sex of the fetus can be determined using ultrasound.

• The end of the third month is the end of the first trimester of the pregnancy

   The Second Trimester (p. 108)

• By the middle of the second trimester (which lasts from 13 to 24 weeks), the fetus has grown large enough that the mother can feel its movements.

• The infant is covered in vernix and lanugo. Vernix is a white cheeselike substance that covers the fetus and protects its skin from becoming chapped in the amniotic fluid. Lanugo is a white downy hair that also covers the fetus and helps the vernix stick to the skin.

• At the end of the second trimester, all the brain’s neurons have been produced. The fetus can now be both stimulated and irritated by sounds and light.

  The Third Trimester (pp. 109-111)

• The age of viability, between 22 and 26 weeks, is the age at which the fetus can first survive if born early.

• The brain continues to make great strides during the last three months. The cerebral cortex enlarges and the fetus spends more time awake. The fetus is also more responsive to external stimulation.

• The fetus moves less often, because of reduced space and a greater ability to inhibit behavior.

• A layer of fat develops under the skin to assist with temperature regulation following birth

• In the last weeks, most fetuses move into an upside-down position. Growth slows and birth is about to take place

III.     PRENATAL ENVIRONMENTAL INFLUENCES (PP. 112-126)

A.         Teratogens (pp. 112-121)("Monster-makers")

1.  A teratogen is any environmental agent that causes damage during the prenatal period.

• Larger doses of teratogens over longer time periods usually have more negative effects.

• The genetic makeup of the mother and the developing organism may enable or hinder their ability to withstand harmful environments.

• The presence of several negative factors at once can worsen the impact of a single harmful agent.

• The effects of teratogens vary with the organism’s age at the time of exposure

        - A part of the body is in a sensitive period when it is undergoing rapid development; it is especially vulnerable to its surroundings during that time.
  - The embryonic period is the time when serious defects are most likely to occur, since the foundations for all body parts are being laid down

• The effects of teratogens may have psychological consequences. These effects may be harder to identi1~’ than physical damage, and may not show up until later in development.

Teratogenic environmental factors:   

1.    Prescription and Nonprescription Drugs (pp. 113-115)

• Thalidomide, a sedative used in the 1960’s, caused severe limb deformations in embryos when taken by mothers between the fourth to sixth week after conception.

• Diethylstilbestrol (DES) was widely prescribed between 1945 and 1970 to prevent miscarriages. Daughters of these mothers showed unusually high rates of cancer of the vagina, malformations of the uterus, and pregnancies resulting in prematurity, low birth weight, and miscarriage.

• Repeated use of aspirin is linked to low birth weight, infant death around the time of birth, poorer motor development, and lower intelligence scores in early childhood.

• Heavy caffeine intake is associated with low birth weight, prematurity, miscarriage, and newborn withdrawal symptoms, such as irritability and vomiting.

• The safest course of action is to cut down or avoid these drugs entirely

2.    Illegal Drugs (p. 116)

• Babies born to users of cocaine, heroin, or methadone arc at risk for prematurity, low birth weight, physical defects, breathing problems, and death around the time of birth. In addition, these infants are often born drug-addicted.

• Evidence suggests that prenatal exposure to cocaine has lasting difficulties. These include genital, urinary tract, kidney, and heart deformities, as well as brain hemorrhages and seizures.

• Babies born to mothers who smoke crack ore worst off in terms of low birth weight and central nervous system damage.

• Fathers may contribute to these negative effects as cocaine may attach itself to sperm and cause birth defects.

• It is difficult to isolate the precise impact of cocaine, because users often take several drugs and engage in other high-risk behaviors.

• Mixed findings regarding the links between marijuana use and low birth weight or prematurity have been documented.

3.      Tobacco (p. 117)

• Effects of smoking during pregnancy include low birth weight and increased chances of prematurity, impaired breathing during sleep, miscarriage, infant death, and cancer later in childhood.

• Some studies report that youngsters exposed prenatally to tobacco have shorter attention spans, poorer mental health scores, and more behavior problems in childhood and adolescence.

• The nicotine in cigarettes causes the placenta to grow abnormally—the transfer of nutrients is reduced and the fetus gains weight poorly.

• Smoking raises the concentration of carbon monoxide in the bloodstreams of both mother and fetus—carbon monoxide displaces oxygen from red blood cells.    

• Passive smoking is also related to low birth weight, infant death, and possible long-term impairments in attention and learning.

4.   Alcohol (pp. 117-118)

• Fetal alcohol syndrome (FAS) is the set of defects that results when women consume large amounts of alcohol during most or all of pregnancy.

• Symptoms include mental retardation; impaired motor coordination, attention, memory and language; over activity; slow physical growth; and facial abnormalities.

• Fetal alcohol effects (FAE) is the condition of children who display some, but not all, of the defects of FAS.

• Usually the mothers drank alcohol in smaller quantities during pregnancyAlcohol interferes with cell duplication and migration in the primitive neural tube.

• Alcohol also requires large quantities of oxygen to metabolize, which draws oxygen away from the developing embryo or fetus.

• A precise dividing line between safe and dangerous drinking levels cannot be established, and it is best for pregnant women to avoid alcohol entirely.

5.    Radiation (pp. 118-119)

• When mothers are exposed to radiation during pregnancy, harm can come to the embryo or fetus.

• As demonstrated by children born to pregnant women who survived the bombing of Hiroshima and Nagasaki and the nuclear power plant accident in Chernobyl, radiation leads to a higher incidence of miscarriage and babies born with underdeveloped brains, physical deformities, and slow physical growth.

• Even when a radiation-exposed baby appears normal, problems may appear later, such as an increased risk of childhood cancer, abnormal EEG brain-wave activity, lower intelligence test scores, and high rates of language and emotional disorders.

6.     Environmental Pollution (p. 119)

• An astounding number of potentially dangerous chemicals are released into the environment in industrialized nations

• Established teratogens include mercury, lead, and polychlorinated biphenyls (PCBs).

7.    Maternal Disease (pp. 119-121) Certain diseases during pregnancy can cause miscarriage and birth defects.

•   Viruses (pp. 119-120)  Rubella (3-day or German measles) can cause a wide variety of abnormalities, especially when it occurs during the embryonic period.  Acquired immune deficiency syndrome (AIDS), a disease that destroys the immune system, is infecting increasing numbers of women. When they become pregnant, they pass it to the developing organism 20-30% of the time. 

• Bacterial and Parasitic Diseases (pp. 119-120) Toxoplasmosis is a parasitic disease caused by eating undercooked or raw meat or contact with the feces of infected cats. During the first trimester, it leads to eye and brain damage.

       B.   Other Maternal Factors (non-teratogenic) that affect pregnancy (pp. 121-124)

1.          Exercise (p. 121) In healthy, physically fit women, regular exercise is related to increased birth weight. Since the growing fetus places some strain on the back, abdominal, pelvic, and thigh muscles, exercises that strengthen these areas arc particularly helpful. In most cases, a mother who has remained fit during the earlier months experiences fewer physical discomforts later in pregnancy.

2.          Nutrition (pp. 121-123)A healthy diet helps ensure the health of mother and baby.

        Consequences of Prenatal Malnutrition: (pp. 12 1-122)Autopsies of malnourished babies who died at or shortly after birth reveal fewer brain cells, a lower brain weight, and abnormal brain organization. Prenatal malnutrition can damage the immune system and the structure of organs, including the pancreas, liver, and blood vessels.

Prevention and Treatment (pp. 122-123)Many studies show that providing pregnant women with adequate food has a substantial impact on the health of their newborn babies.

• Finding ways to optimize maternal nutrition through vitamin—mineral enrichment as early as possible is also crucial.

• Folic acid can prevent abnormalities of the neural tube.

• Successful intervention after birth must not only provide nutrients, but must also break the cycle of strained and apathetic mother—baby interactions

3.          Emotional Stress (p. 123)  Intense stress during pregnancy is associated with a higher miscarriage rate, prematurity, low birth weight, newborn irritability, respiratory illness, digestive disturbances, and certain physical defects.

• When a mother experiences fear and anxiety, blood supply increases to the brain, heart, and limbs resulting in decreased blood supply to the uterus.

• Stress hormones also cross the placenta.

• Risks are greatly reduced when mothers have supportive significant others whom they can turn to for emotional support.

 4.    Rh Blood Incompatibility (p. 123)  The Rh factor is a protein that, when present in the fetus’s blood but not in the mother’s, can cause the mother to build up antibodies which can return to the fetus’s system and destroy red blood cells.

• The danger increases with each additional pregnancy.

• The harmful effects of Rh incompatibility can be prevented in most cases.

5.   Maternal Age and Previous Births (p. 124)Women who delay having children until their thirties or forties face a greater risk of infertility, miscarriage, and babies born with chromosomal defects.

• For women without serious health difficulties, those in their forties do not experience more prenatal problems than do those in their twenties.

• A teenager’s body is usually physically capable of supporting a pregnancy. However, problems arise when adolescents do not have access to medical care or are afraid to seek it.

C.  The Importance of Prenatal Health Care (pp. 124-125)

1.   Regular prenatal checkups help ensure the health of both the mother and fetus.

2.   Toxemia is an illness of the last half of pregnancy in which the mother’s blood pressure increases and her face, hands, and feet swell. If untreated, it can cause convulsions in the mother and death of the fetus.

3.   Lack of health insurance, situational barriers, psychological stress, demands of taking care of other young children, lack of transportation, ambivalence about the pregnancy, family crises, and lack of belief in the benefits can deter mothers from obtaining prenatal care.

A.           Seeking Information (p. 126)
1.   The gradual changing of the mother’s body makes the baby a current reality.
2.   Fathers and siblings can share the reality of the baby by seeing the fetus through ultrasound images and by feeling the fetal movements when touching the mother’s abdomen.
3.   Parents get to know the fetus as an individual and may form an emotional attachment to the new being.

B.  The Baby Becomes a Reality (pp. 126-127)
1.   Reading books and talking to doctors about pregnancy and childbirth promote parental adjustment.
2.   Information can make a pregnant woman feel more confident about her ability to be a good mother.

C.         Models of Effective Parenthood (p. 127)
1.  Expectant parents who have good relationships with their own parents already have positive parental models to emulate.
2.   It is possible for prospective parents to rely on other sources in developing an optimistic view of themselves as parents.
3.  Special intervention programs help many people come to terms with negative experiences in their own childhoods.

D.         Practical Concerns (pp.127-128)
1.   Culture affects how long pregnant women continue employment and other activities.
2.   American mothers often work and travel until the end of their pregnancies.
3.   In contrast, Japanese mothers change their daily schedules almost immediately because they believe it is necessary to protect the health of the baby.

E.   The Parental Relationship (p. 128)
1.   Evidence indicates that pregnancy adds to rather than subtracts from family conflict if a marriage is in danger of falling apart.
2.   Pregnancy changes role assignments and expectations for both the expectant mothers and fathers.
3.   When a marriage is based on love and respect, parents are well equipped to face the challenges of pregnancy.

I.       THE STAGES OF CHILDBIRTH PP. (134-139)

A.         Several signs indicate that labor is near.
1.  False labor or prelabor occurs when the uterus sporadically contracts for several weeks before the actual birth.
2.  About 2 weeks before birth, an event called lightening occurs. The baby’s head drops low into the uterus and the cervix softens in preparation for delivery.
3.  The bloody show is the reddish discharge released when the cervix widens.

B.   Stage 1: Dilation and Effacement of the Cervix (pp. 134-13 5)
1.  Stage 1 is the longest stage of labor—lasting, on average, 12 to 14 hours with a first baby and 4 to 6 hours with later births.
2. Dilation and effacement of the cervix is the widening and thinning of the cervix resulting in a clear pathway from the uterus into the birth canal.
3.    Uterine contractions are forceful and regular. Gradually, they get closer together, occurring every 2 to 3 minutes, and become more powerful, continuing for as long as 60 seconds.
4.  Transition is reached when the frequency and strength of contractions are at their peak and the cervix opens completely.

C.   Stage 2: Delivery of the Baby (pp. 136-137)
1.   In Stage 2, which lasts approximately 50 minutes for a first baby and 20 minutes in subsequent births, the infant is born.
2.   Strong contractions continue, and the mother feels a natural urge to squeeze and push with her abdominal muscles, forcing the baby down and out.
3.   An    is a small incision that increases the size of the vaginal opening and permits the baby to pass without damaging the mother’s tissues.
4.   The baby’s head crowns when the vaginal opening stretches around the entire head.

D.   Stage 3: Birth of the Placenta (p. 137)
1.  The final stage lasts about 5 to 10 minutes.
2.   The final contractions and pushes cause the placenta to separate from the uterine wall and be delivered.

E.   The Baby’s Adaptation to Labor and Delivery (pp. 137-138)
1.   The force of the contractions causes the infant to produce high levels of stress hormones.
2.   Stress hormones send extra blood to the brain and heart, helping the infant withstand oxygen deprivation. In addition, this helps prepare the lungs to breathe, and arouses the infant into alertness at birth.

APPROACHES TO CHILDBIRTH (PP. 139-14 1)

A.           Childbirth practices vary around the world.

B.   In large Western nations, childbirth has changed dramatically over the centuries.
1.   Before the 1 800s, childbirth usually took place in the home and was a family-centered event.
2.  The industrial revolution brought greater crowding in cities and new health problems; consequently, childbirth moved to the hospital. Doctors assumed responsibility for childbirth.
3.  By the l9SOs and 1960s, the routine use of medical procedures during labor and delivery was questioned by many, and the natural childbirth movement arose.
4.  Most hospitals today offer birth centers that are family-centered and homelike.
5.     Freestanding birth centers operate independently of hospitals and offer less backup medical care.
6.  A small but growing number of women are choosing to have their babies at home.

C.   Natural, or Prepared, Childbirth (pp. 140-141)
1.         Natural, or prepared, childbirth is an approach designed to reduce pain and medical intervention and to make childbirth a rewarding experience for parents.
2.         Natural childbirth programs typically consist of three parts:a.  Information about labor and delivery including classes that educate parents about the anatomy and physiology of labor and delivery.b. Relaxation and breathing techniques that are used by the mother to counteract the pain of the contractions.c. Training of labor coaches who offer physical and emotional support to the mother during the birth.
3.     Social support is important to the success of natural childbirth techniques. Continuous support from a trained companion during labor and delivery strengthens these outcomes.
4.         Positions for Delivery (pp. 140-141)a. In birth center or home deliveries, mothers often give birth in the upright, sitting position rather than lying flat on their backs with their feet in stirrups.  In Europe, women are encouraged to give birth on their sides to reduce the need for an episiotomy.  Research findings favor the sitting position. Labor is shortened, because pushing is easier and more effective. The baby also benefits from a richer supply of oxygen because placental blood flow is increased.

     D.    Home Delivery (p. 141
1.  Mothers who choose home delivery want birth to be an important part of family life. In addition, most want to avoid unnecessary medical procedures and desire greater control over their own care and that of their babies than most hospitals permit.
2.  Many home births are handled by nurse-midwives who have degrees in nursing and training in childbirth management.
3.  When mothers are at risk for any kind of complication, the appropriate place for labor and delivery is the hospital, where life-saving treatment is available.

III.     MEDICAL INTERVENTIONS DURING LABOR AND BIRTH(PP. 141-142)  More than anywhere else in the world, childbirth in the United States is a medically monitored and controlled event.

A.   Fetal Monitoring (p. 140)
1.  Fetal monitors track the baby’s heart rate during labor.
2.  Fetal monitoring is a safe medical procedure that has saved the lives of many babies in high-risk situations.
3.  Drawbacks: Nevertheless, the use of fetal monitors is, at times, controversial. Critics think fetal monitors falsely identify babies as being in danger and fetal monitoring is linked to an increase in the number of emergency cesarean deliveries. Many women complain that the monitors are uncomfortable and restrictive.

B.   Labor and Delivery Medication (p. 142)
1.  Some form of medication is used in 80 to 95 percent of births in the United States.
2.  Analgesics are pain-relieving drugs that help the mother relax.
3.  Anesthetics are stronger painkillers that block sensation.
4. Drawbacks: Anesthetics weaken uterine contractions during the first stage of labor and interfere with the mother’s ability to feel contractions and push during the second stage, prolonging labor. Also, since medications rapidly cross the placenta, the newborn may be sleepy and withdrawn, suck poorly during feedings, and be irritable when awake. Some experts claim the use of medications during childbirth has a lasting impact on physical and mental development, but their findings have been challenged.

C.    Instrument Delivery (p. 142) Sometimes due to difficulties during delivery, instruments have to be used.
1.  Forceps are metal clamps placed around the baby’s head to pull the infant from the birth canal.
2.  A vacuum extractor is a suction tube that is attached to a plastic cup placed on the baby’s head.
3.  Instrument delivery is used when the mother’s pushing during the second stage of labor does not cause the baby to move through the birth canal in a reasonable amount of time.
4.  In the United States, forceps or vacuum extractors are used in about 12 percent of births. They are used less than 5 % of the time in Europe. Their use can result in head injury or brain damage.
5.  Neither method should be used when the mother can be encouraged to deliver normally, and there is no special reason to hurry.

E.          Induced Labor (p. 143)
1.  An induced labor is started artificially by breaking the amnion and giving the mother a hormone that stimulates contractions.
2.   This is used when continuing the pregnancy threatens the well-being of mother or baby. Too often, though, labors are induced for the doctor’s or patient’s convenience.
3.   The contractions of an induced labor are often longer, harder, and closer together than those of a naturally occurring labor.
4.   Labor and delivery medication is more likely to be used in larger amounts, and there is a greater chance of instrument delivery.
5.   The placental hormone CRH helps predict the success of induction procedures.

F.         Cesarean Delivery (pp. 143-144)
1.   A cesarean delivery is a surgical birth in which the doctor makes an incision in the mother’s abdomen and lifts the baby out of the uterus.
2.   In 1994, cesareans accounted for 24 percent of American births. The rate dropped slightly to 21 percent in 1999. Still, this is the highest rate in the world.
3.   Cesareans have always been warranted by serious medical emergencies. However, surgical delivery is not always needed in other instances.
4.   When babies are in a breech position (turned so that the buttocks or feet would be delivered first) cesareans are often justified.
5.   Although the operation is safe, mothers need more time for recovery and cesarean newborns are more likely to be sleepy and unresponsive and to have breathing difficulties.

       BIRTH COMPLICATIONS (PP. 144-15 1)

A.         Oxygen Deprivation (pp. 144-145)
1.   Cerebral palsy is a general term for a variety of problems—all involving muscle coordination—resulting from brain damage before, during, or just after birth.
2.   Anoxia is an inadequate supply of oxygen during labor and delivery. It may be caused by squeezing of the umbilical cord, placenta abruptio (premature separation of the placenta) or placenta previa, a condition where the placenta covers the cervical opening, causing part of the placenta to detach as the cervix dilates and effaces.
3.   Most oxygen-deprived newborns remain behind their peers in intellectual and motor development through early childhood. By the school years, most catch up in development.
4.   Researchers are experimenting with ways to prevent ongoing brain damage after birth.
5.  Respiratory distress syndrome is a disorder of preterm (premature)  infants in which the lungs are so immature that the air sacs collapse, causing serious breathing difficulties.