Chapter 4

Prenatal Development and Birth

The Developing Person Through the Life Span Kathleen Stassen Berger • Tenth
Prenatal Growth (part 1)

• Three main periods of prenatal development

– Germinal period (1st two weeks after conception):
Rapid cell division and beginning of cell
differentiation

– Embryonic period (3rd through 8th week): Basic

forms of all body structures develop

– Fetal period (9th week until birth): Fetus grows in

size and matures in functioning
Prenatal Growth
(part 2)
• Can you define these
terms?
– Beginning of
pregnancy
– Length of pregnancy
– Trimesters
– Due date
First Stages of the Germinal Period

• The original zygote as it divides into two

cells, four cells, and then eight cells

• Occasionally at this early stage, the cells

separate completely, forming the
beginning of monozygotic twins,
quadruplets, or octuplets.
Germinal Period:
First 14 Days
• Zygote begins
duplication and
division within hours
of conception.
– Development of the
placenta
– Implantation (about 10
days after conception)
– Organism grows
rapidly
 Vulnerability During Prenatal
Development
Period Vulnerability
The Germinal Period About half of all conceptions fail to
grow or implant properly and thus do
not survive the germinal period. Most of
these organisms are grossly abnormal.

The Embryonic Period About 20 percent of all embryos are

aborted spontaneously, most often
because of chromosomal
abnormalities.
The Fetal Period About 5 percent of all fetuses are
aborted spontaneously before viability
at 22 weeks or are stillborn (defined as
born dead after 22 weeks).

Birth About 31 percent of all zygotes grow

and survive to become living newborn
babies.
The Embryonic Period: From the Third
Week Through the Eighth Week
• Embryo
– Primitive streak becomes the neural tube and
later forms the brain and spine of the CNS.
– Head takes shape.
– Eyes, ears, nose, and mouth form.
– Heart begins to pulsate.
– Extremities develop and webbed fingers and
toes separate.
The Embryonic Period

(a) 4 weeks past conception (b) 7 weeks

The Fetal Period

• Fetus
– Ninth week after conception until birth
– Genitals form and sex hormones cause
differences in brain organization.
– Cephalocaudal and proximodistal growth
– Heartbeat detectable via stethoscope
– Cortex is not fully mature at birth.
– Brain at birth is biggest part of baby.
Fetus: From Ninth
Week Until Birth
The third month
• Rapid growth with
considerable variation

• Average: 3 months; 3
ounces; 3 inches

• 9th week: SRY gene triggers

development of sex organs

• 3rd month: Neurological sex

differences begin
Fetus: The Middle
Three Months
Middle three months
• Digestive and excretory
systems develop.
• Fingernails, toenails, and
buds for teeth form, and
hair grows (including
eyelashes).
Fetus: The Middle Three Months Part 2

• Brain
– Experiences rapid growth
– Follows proximodistal sequence from brain
stem to midbrain to cortex
– Develops many new neurons (neurogenesis)
and synapses (synaptogenesis)
– Begins to regulate basic bodily functions as
entire CNS becomes responsive
Prenatal Growth of the Brain
Fetus: The Final
Three Months
• Last three months
– Involves expansion
and contraction of
lungs
– Includes final
maturation of heart
valves, arteries, and
veins
– Provides time for
extensive growth and
folding in cortex
Birth

• Fetal brain signals the release of

hormones to trigger the female's
uterine muscles.
– Labor begins
• Average duration for firstborn babies: 12 hours
• Quicker labor for later-born babies
• Birthing positions vary
• Sitting, squatting, lying down, water births
• Cultural and personal preference
A Normal, Uncomplicated Birth
The Newborn’s First Minutes

• Newborns
– Usually cry spontaneously
– Color changes from bluish to pinkish
– Eyes open, fingers grab, toes stretch
• Apgar scale
– Quick assessment of newborn's heart rate,
breathing, muscle tone, color, and reflexes
– Completed twice (1 minute and 5 minutes after birth)
– Score of 0, 1, or 2 in each category
– Desired score: 7 or above
 Criteria and Scoring of the Apgar Scale

Five Vital Signs Five Vital Signs Five Vital Signs Five Vital Signs Five Vital Signs Five Vital Signs

Score Color Heartbeat Reflex Irritability Muscle Tone Respiratory

Effort

0 Blue, pale Absent No response Flaccid, limp Absent

1 Body pink, Slow (below 100) Grimace Weak, inactive Irregular, slow
extremities blue

2 Entirely pink Rapid (over 100) Coughing, sneezing, Strong, active Good; baby is crying
crying

Source: Apgar, 1953/2015.

Medical Assistance (part 1)

• Characteristics of childbirth depend on

several variables.
– Parents’ preparation
– Position and size of fetus
– Customs of culture
• In most developed nations childbirth
includes
– Sterile procedures
– Electronic monitoring
– Drugs to dull pain or speed contractions
Alternatives to
Hospital Technology
• Home births
• Doula
– Woman who helps
with labor, delivery,
breast-feeding, and
newborn care
– May be related to
lower rate of cesarean
sections
Medical Assistance
(part 2)
Surgery: Cesareans
• Are controversial
• Involve surgical birth
• Vary by rates and
reasons for use
• Present advantages for
hospitals; more
complications after birth
Medical Assistance (part 3)

• Surgery
– Epidural
– Induced labor

• Alternative to hospital technology

– Planned home births
Newborn Survival
• 2 million newborns
worldwide die yearly;
300,000 women die in
pregnancy or birth, may
be higher in poorest
nations
• Currently, less than 1 in
250 neonatal deaths in
the United States; better
rates of newborn survival
in 40 other nations
Problems and Solutions

• Harmful substances
– Prenatal teratogens
– Any agent or condition, including viruses and
drugs, resulting in birth defects or complications

• Behavioral teratogens
– Agents and conditions that can harm the prenatal
brain, impairing the future child's intellectual and
emotional functioning
Risk Analysis Factors

• Risk analysis discerns which chances are

worth taking and how risks are minimized.
– Critical time
– Dose and/or frequency of exposure (threshold
effect)
– Innate vulnerability
Risk Analysis: How Much Is Too Much?

• Threshold effect
– Certain teratogens are relatively harmless
until exposure reaches a certain level.
– Thresholds are controversial.
• Example: Alcohol consumption
– Embryo exposed to heavy drinking can
develop fetal alcohol syndrome (FAS).
– FAS is more apparent when women are
poorly nourished and cigarette smokers.
Risk Analysis: Innate Vulnerability

Genetic vulnerability
• Some zygotes carry genes that make them vulnerable.

• Male fetuses are more vulnerable to teratogens than

female ones.

• Mother’s genes affect the prenatal environment she

provides.

• Neural-tube defects are more common in certain ethnic

groups (e.g., Irish, English, and Egyptian).
Risk Analysis: Advice from Experts

Advice from Doctors Advice from Scientists

• Problems
– Provision of potentially
dangerous prescriptions for
pregnant women
– Failure to take time to
understand woman’s life
patterns
• Problems
– Provision of contradictory
interpretation of research
that led to opposite
message
Prenatal Diagnosis

• Early care protects fetal growth, makes

birth easier, and renders parents better
able to cope.
• When complications arise, early
recognition increases the chance of a
healthy birth.
• About 20 percent of early pregnancy tests
raise anxiety instead of reducing it.
• False positives
Low Birthweight

• Low birthweight
(LBW)
• Very low birthweight
(VLBW)
• Extremely low
birthweight (ELBW)
• Preterm
• Small for gestational
age (SGA)
Low Birthweight and the Mother

• Maternal behavior
– Maternal health and illness
– Maternal drug use before and during pregnancy
• Maternal malnutrition
– Women who begin pregnancy underweight,
who eat poorly during pregnancy, or who gain
less than 3 pounds (1.3 kilograms) per month in
the last six months more often have
underweight infants.
What About the
Father?
• Indirect influence of
risk for adverse birth
outcomes (Misra et
al., 2010)
– Father’s attitude
– Father’s behavior
– Relationship between
mother and father
– Hispanic paradox
Low Birthweights:
Comparing Nations
• The United States has a
low-birthweight rate of about
8.2 percent—ranking worse
than most developed
nations.

• Worldwide, far fewer low-

birthweight babies are born
today than 20 years ago.

• Neonatal deaths have been

reduced by one-third as a
result.
Complications During Birth

• When a fetus is at risk, birth

complications become likely.
– Example: Cerebral palsy
• Anoxia-related damage related to varied
factors, such as:
– Genes
– Birthweight
– Gestational age
– Drugs in bloodstream
Food Insecurity
The New Family: The Newborn

• Newborns seek to protect themselves

with three sets of reflexes
– Maintaining oxygen: Breathing, hiccupping,
sneezing
– Maintaining constant body temperature:
Crying, shivering, tucking legs to body,
pushing
– Managing feeding: Sucking, rooting,
swallowing
The Newborn

• Brazelton Neonatal Behavioral

Assessment Scale (NBAS)
– Test often administered to newborns that
measures responsiveness and records 46
behaviors, including 20 reflexes
– Parents who watch their infant perform on the
NBAS are amazed at the newborn’s
responses—and this fosters early parent–
child connection.
The New Family:
The Newborn Part 2
• Other reflexes are not
necessary for survival
but signify the state of
brain and body
functions.
– Babinski reflex
– Stepping reflex
– Palmar grasping reflex
– Moro reflex
The New Family: Mothers

• About half of all women experience

physical problems after birth.
– Between 8 and 15 percent of women
experience postpartum depression.
• Feelings of sadness and inadequacy
• Symptoms from baby blues to postpartum
psychosis
• May involve struggles with adequate baby care
• Varied causes
The New Family: Fathers

• Not only fathers but the entire social

network and culture are crucial
influences.
– Father's role
• Helping mother stay healthy
• Helping mother manage stress (affects fetus)
• Providing legal acceptance of the birth
– Couvade
• Symptoms of pregnancy and birth experienced by
fathers
Parental Alliance

• Parental alliance
– Involves commitment by both parents to
cooperate in raising the child
– Is especially beneficial when infant is
physically vulnerable
Bonding

• Parent–infant bond
– Bonding involves a
strong, loving
connection that forms
as parents hold,
examine, and feed the
newborn.
– Early skin-to-skin
contact is not essential
for human bonding.