The Birth Process
As delivery time nears, the mother’s calcium level drops. This decrease is particularly marked in the pelvic area so that the mother’s pelvis can be extended as widely as possible to accommodate the fetus. Simultaneously, muscles around the uterus and cervix also become larger and more flexible to accommodate the fetus during birth. In preparation for birth, the fetus rotates in the womb so that it will be born head first. This rotation is triggered by hormonal action in the mother and is the first indication of the onset of labor. If fetal rotation does not occur, the baby will be born feet first. This awkward type of delivery is called a breech delivery and occurs in about 3 to 4% of births, with increased frequency noted in preterm deliveries (i.e., 25% prior to 28 weeks gestation, 14% at 29 to 32 weeks gestation, 7% at 32 weeks gestation) (Lee et al., 1998). A breech delivery can cause anoxia (lack of oxygen), intracranial hemorrhage (bleeding), and transient lowering of the fetal heart rate, particularly in the premature infant (DeCherney, Nathan, & Goodwin, 2006). Although a breech delivery typically is not of major consequence to outcome, some association has been made to abnormalities in the child, with central nervous system anomalies being noted most frequently (Mazor, Hagay, Leiberman, Biale, & Insler, 1985). In addition, nearly half of all cases of hydrocephalus, myelomeningocele, Prader-Willi syndrome, and trisomy are associated with breech presentation (Krebs & Langhoff-Roos, 2006).
Other factors that can affect the baby include pressure in the birth canal, the use of forceps during delivery, and the sedation of the mother. This latter factor can be critical because the baby’s immature liver and excretory systems experience difficulties eliminating maternal medications and anesthesia from the body. This may contribute to sedation and, consequently, to a baby who initially may be less responsive to environmental stimulation—including its parents (Murray, Dolby, Nation, & Thomas, 1981).
When there is a possibility of an abnormal vaginal delivery, a cesarean section (c-section) can be performed. In this procedure, the mother’s abdomen and uterus are surgically opened, and the baby and placenta are removed. This procedure eliminates many of the risks associated with an abnormal delivery for the mother as well as for the child. One factor that can indicate the need for a c-section is postmaturity. Postmaturity refers to a baby being post-term, or after the 41st week. About 10% of babies are born after the 41st week of gestation (Coustan, 1995). Although most babies show no permanent signs of being post-mature, largely because of routine and careful prenatal monitoring, some post-mature babies do not obtain sufficient nutrients and oxygen from the placenta to meet the demands of labor (White, 2004), and thus brain injury or death can occur.
Despite reports of significant morbidity of later occurring disorders following perinatal complications (Dean & Davis, 2007), from this point forward, the baby grows and develops in a remarkable fashion. One area that the early interventionist should be well versed in is developmental milestones. In addition to the discussion below, Table provides an overview of many of the major developmental milestones from infancy through the preschool years. These milestones should be “hard wired” into the knowledge base of the early interventionist.
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