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Child Development - Growth before birth

Pre-natal Development

The term prenatal refers to the period before birth. It is a very special time. During this 40 week (or nine - months) period, a single cell develops into a human being capable of independent existence.

The forty - week Miracle
Prenatal development beings at conception. It continues through three stages: the period of the ovum, the period of the embryo, baby develops.

Conception

Once each month, a female cell or egg called an ovum - is released by the ovary of a woman. The egg moves through the fallopian tube to the uterus, or womb. This journey requires about two or three days. It is only in the fallopian tube that by a sperm, or male cell, conception takes place.

When the egg reaches the uterus, it usually disintegrates and is flushed away with the menstrual in the fallopian tube by a sperm, or male cell, conception takes place. This is the beginning of pregnancy.

Period of the Ovum

The first stage in the life of a human baby is called the period of the ovum. It lasts approximately two weeks. When the fertilized egg reaches the uterus, it attaches itself to the thickened lining of the uterus and begins to grow. Since the lining is needs to nourish the fertilized egg, it cannot be shed in menstruation as usual. Therefore, menstruation does not take place. The woman's menstrual periods stop and will not begin again until after the baby is born.

The fertilized egg has found a soft, warm bed and food in the thickened lining of the uterus. It grows by a process called cell division. This single, complete cell divides and becomes two; two become four, and so on until there is a mass of cells. Each cell is programmed to become a particular type. Some will help form skin or bones. Others will become brain or blood cells. In spite of the remarkable growth in this two - week period, the tiny ovum is still only the size of a pinhead.

Period of the Embryo

The increasing cluster of cells is called the embryo. The second stage of development - the period of the embryo lasts about six weeks.
The embryo is growing rapidly. It becomes firmly attached to the inner lining of the uterus. By the end stage, the connecting tissue between the embryo and the uterus has developed into the Placenta. Nourishment and oxygen from the mother's bloodstream are carried from the placenta to the developing baby through the umbilical cord.
Many mothers worry that during their pregnancy, the baby may become tangled up in the umbilical cord and strangle. This is very unlikely. The cord is, filled with blood. It is as stiff and firm as a garden hose filled with water. It is not flexible enough to loop around the fetus. Only after baby is born does the cord become limp and ropelike.

The growing embryo is soon surrounded by a bag of liquid called amniotic fluid. This acts as a cushion to protect it, even through minor bumps or falls of the mother. The baby remains within this sac of liquid until just before birth.

Period of the fetus

The third and last stage of pregnancy is called the fetal period, it beings about the seventh or eighth week of pregnancy, and lasts until birth. The new life is now known as the fetus rather than the embryo.
The unborn baby is now more recognizable. Arms, legs, and even fingers and toes have developed. Facial features are also forming. All of the internal organs are present, but not all are ready to function yet. They continue to develop in the remaining months.
Somewhere between the fourth and fifth months, the fetus's movements and kicks touch the wall of the uterus. These fluttering movements will be faint and infrequent at first. Gradually, they become stronger and occur more often. This feeling life, sometimes called "quickening" tells the mother that she does, indeed, carry a live child within her. Actually, the baby has been very active long before this.
The doctor will want to know when the expectant mother first felt life. These help the doctor estimate the baby's fetal age and establish a more accurate birth date. When life is felt, the fetus's heartbeat can also be heard.
As the growing fetus fills more and more of the space in the uterus, the surrounding fluid fills only the pockets around the baby's body. With less space to stretch out, the baby curls up. This is called the fetal position.

By the seventh month, the most rapid fetal development has already taken place. Now the fetus's main job is get ready for birth. In these last months, the major organs become ready to sustain life outside the womb. The fetus also gains weight rapidly. Fat deposits are added under the skin. These will help the baby maintain body heat after birth. Gradually, the fetus, which had been thin, wrinkled, and old - looking, takes on the smoother, rounder appearance of a baby. The fetus is also storing nutrients and building immunity to diseases and infections.
The unborn baby can do a surprising number of things for one so tiny. It can suck its thumb, cough sneeze, yawn, and suffer hiccups. A baby can cry before birth. Usually the crying is soundless. In one case, however, a doctor injected an air bubble into the uterus for medical purposes. The bubble happened to cover the baby's face. The moment the fetus had air to inhale and exhale, the sound of a protesting wail could clearly be heard.
One day during the ninth the baby's weight seems to shift unexpectedly. Somehow the mother feels much more comfortable. "Lightening" has occurred. This means the baby has dropped into the lower pelvis. Birth is not far off. If this is not a first baby, lightening may not occur until just before labor begins. Sometimes lightening is accompanied by slight abdominal pains which first - time mothers may mistake for the beginning of labor.
By now the baby is probably upside down with the head nestled in the pelvis. This is the most comfortable position for the baby. It is also the easiest and safest position for birth. The baby is less active now because it fills most of the available space.
The skin of the mother's abdomen appears stretched to capacity. The abdominal muscles are too. Nature has miraculously provided for this the muscles of the uterus and abdomen are capable of being increased up to sixty times their original size during pregnancy, yet they will return to nearly their original size within a month or so after the birth. The nine months of pregnancy are over the baby is ready to be born.

THE BIRTH PROCESS

A normal birth always follows the same pattern. As the unborn baby becomes developed enough to exist independently, the muscles of the mother's uterus push to expel the fetus from her body. This process is known as labor. It is still not known what signals the uterus to begin the birth process.
Although the distance the fetus must travel is short - only 4 inch. It is a difficult journey. The baby must be pushed through the bony pelvic passage and the narrow vaginal canal. Fortunately, nature has arranged to make this easier. The unborn baby's skull is soft and flexible so it can become longer and narrower. It consists of five soft, pliable bones which overlap each other to fit through the pelvis. This "molding" helps the baby's skull pass through the mother's pelvis more easily.

The Beginning of Labor

Labor may start in one of three ways:

The expectant mother may notice slight cramps and a backache. This may not concern her first because she has probably felt this way occasionally for the last few weeks. Gradually she will realize that these cramps are different. They are not getting weaker as they did before; they are getting stronger and longer. As she has been told, she will watch the clock to see if these cramps come at regular intervals. At first they may appear every half hour or so , then every 25 minutes. As each cramp comes, the muscles of the abdomen tighten. As the cramp passes, the muscles relax. When these cramps - or contractions - become very regular and continue to become stronger active labor has probably start. It is time to notify the doctor or nurse - midwife. He or she will want to know two things - how often the mother is having contractions and how long each one lasts. The doctor will advise the mother from there.
For another expectant mother labor may begin differently. She may feel fine and be following her usual routine. Suddenly, she feels a warm trickle or gush of liquid from her vagina. She has been told of this possibility and knows want it is. The membrane holding the amniotic fluid which surrounds the baby has broken and the fluid is draining away. When this happens, the mother should note the time, the amount of fluid, and the color and odor of the fluid. She should then inform her doctor or nurse - midwife. He or she will probably want to deliver the baby within 24 to 48 hours after the membrane has broken to avoid possible infection to the baby.
Other mothers may become aware that labor is near when "shown" appears. This may be a few drops of blood or a slight pinkish vaginal staining. This often means that the plug of mucus that sealed the cervix - the lower part of the uterus - has become loose. Show does not always mean that labor has begun. It is possible to have shown several days before labor begins. It dose mean that things are ready to start. The mother should notify the doctor or nurse - mid wife if this happens.

Stages of Labor
When actual labor begins, it progresses through three stages:

First stage: contractions open the cervix.
Second stages: the baby is born.
Third stage: the placenta is expelled.

The First Stage

The first stage of labor is the longest. It may last as long as 12 hours. In the beginning, the contractions are mild and brief. They probably occur about 15 to 30 minutes apart. These contractions cause the cervix to dilate (widen) and become thinner. Ordinarily, the opening of the cervix is about the size of the end of a pencil. For birth, it must widen to about 4 in. (10cm) in diameter. The cervix normally about ¾in. (19 mm) thick becomes as thin as a piece of paper

As the hours pass, the contractions become progressively stronger, more frequent, and longer lasting. The doctor or nurse midwife will tell the expectant mother when to go the hospital or birthing center. As the cervix is opening, the baby will probably move down into the lower pelvis and into position for birth. The baby is usually head down, but occasionally babies are born in other positions. In this stage of labor, the mother can help most by relaxing as much as possible between and during contractions. Fear and tension cause muscles to tighten. This slows up labor and makes it more difficult. If the mother has taken a prepared childbirth education class, she will do breathing exercises with her coach to relax and help the labor progress. She should also change her position every 30 minutes. If necessary, the mother may be given medication to reduce the discomfort of labor. Depending on what type is used, the effects range from numbing the area around the cervix to putting the mother to sleep. Many of these drugs can affect the newborn, making the baby sluggish instead of alert. Some also interfere with the mother's ability to push during labor. Most doctors and children educators encourage expectant mothers to give birth without drugs, if possible. However, medication will be given if the mother requests it or if complications call for use.

As the first stage of labor ends the contractions are very strong and frequent. With each contraction, the cervix stretches and opens more. When the cervix is fully dilated, room. The first stage is over.

The Second stage

As soon as the cervix is completely dilated and the contractions are about two to four minutes apart, the second stage of labor will begin. This stage lasts from a few minutes up to three hours. It includes the actual birth. During the second stage, the movement of the uterus changes. The cervix is no longer opening. Instead, the contractions push the baby out through the pelvis vagina. In some hospitals, the mother having a normal delivery may remain in the birthing room, a home - like room designed especially for a comfortable labor and safe delivery. In other hospitals, the mother may be moved from the labor room to a separate delivery room. The mother can usually help during this stage. She will be told how and when to help her muscles bear down to make the baby come along. The mother will feel a constant and uncontrollable urge to bear down. However, she will be instructed to push only during a contraction.

If necessary, the doctor will perform a surgical procedure called an episiotomy. For this, the physician makes an incision (cut) to enlarge the external opening of the vagina. (The normal opening is about 1 in. [2.5 cm] smaller than the baby's head.) Enlarging the opening this way is occasionally done to protect a larger baby's head from excessive pressure from the muscles. It also prevents the mother's tissues from being torn by the baby. The clear incision heals better than a ragged tear. The mother is now ready for delivery. The most common procedure is for the mother to lie in a semi - sitting position with her knees flexed. Her legs are supported at the sides of the delivery table in stirrups. Sometimes an ordinary hospital bed or a special birthing chair is used instead.

The baby's head usually emerges first. This is followed gently by one shoulder, then the other. Then the rest of the slippery little body slides through. The baby is born!

Sometimes, forceps must be used by the doctor to help guide the baby's head during delivery. Forceps are specialized tongs made from bands of surgical steel that are molded to fit the shape of a baby's head. With this instrument, the doctor can better control the movement of the head, helping the baby emerge more quickly or slowly as needed.

The Third Stage

In the third stage labor, the uterus continues to contract to expel the placenta - sometimes referred to as the "afterbirth". This stage lasts anywhere from two minutes to half an hour. It involves little or no discomfort.

The uterus contracts as the air is let out. As this happens, the placenta begins to separate from the uterus. It is soft and comes away easily. The doctor will ask the mother to push again to expel the placenta. The Birth process is now completed.

The Newborn at Birth

The newborn is no longer completely dependent on the mother's body for life support. During birth, many changes take place in the infant's circulatory system so that it can survive on its own

. As the birth process begins, the pressure of being squeezed down the birth canal forces much of the fluid out. When the baby emerges, the pressure is released and the lungs automatically expand. The baby's first breath is taken.

Usually the breathing reflex continues on its own. If necessary, the doctor or nurse midwife may gently rub the baby's back to get the process started. Any fluid that remains in the lungs or mouth is gently suctioned out.

Once the lungs have begun taking in oxygen, the baby's circulatory system changes. A valve in the heart closes and over the next few days becomes permanently sealed. Blood now circulates to and from the loungers, instead of bypassing them as before. The umbilical cord, through which the baby has received oxygen and nourishment, is no longer needed. Within a few minutes it stops pulsing and begins to shrink. The cord is clamped, tied and cut off.

How Dose the Newborn Look?

The newborn's head is wobbly and large-one-fourth the size of the body. It may appear strangely lopsided or pointed from the passage through the birth canal. The bones of a baby's skull are tightly knitted together as they are in adults. They can be molded together during birth without harm. Any such lopsidedness is temporary. Babies have two fontanels - or open -spaces - in the bones of the head. The largest of these "soft spots" is just above the baby's forehead. Most babies also have a fontanel to ward the back of the head. These spaces allow the bones of the baby's skull to move together during birth. As the baby grows older, usually between the ages of six and eighteen months, the bone structure comes together to cover the space completely. Meanwhile, the soft spots are protected by skin that is as tough as heavy canvas.

The newborn typically has fat cheeks, a short, flat nose and a receding chin. These features are useful for sucking purposes because the nose and chin are out of the way.

At birth, a baby's eyes are nearly adult size. They are usually dark grayish - blue at birth. Permanent eye color becomes apparent within several months.

The skin of the newborn is blotchy. The baby's circulation is not yet regulated so the fingers and toes may feel cold and appear bluish. The hands and feet may peel if any of the cheesy material that covered the baby's skin before birth remains.

The Postnatal Period

The moment of birth signals the end of nine months of development and anticipation. Of course, it is also called a neonate, and parents will go home to begin their new life together. First however the staff at the hospital or birthing center must make sure the new family gets off to a good start.

Examining the Newborn

Shortly after delivery, the neonate's physical condition is evaluated using a rating system called then Apgar scale. the infant is given are rating from 0 to 2 on each of five item : pulse , breathing , muscle tone , responsiveness , and skin color . A total score 7 to 10 is considered normal. A lower score is a sign that the baby needs special medical attention. Usually the Apgar evaluation is given one minute after birth. The baby is also given a brief examination to check for any conditions that would require special care. Within 60 minutes of delivery, drops of silver nitrate or an antiseptic ointment are put in the baby's eyes to guard again infection. The baby is weighed, measured, and perhaps washed. A permanent copy of the baby's foot -prints are made for public record. Two bands giving the baby's family name are clamped to the wrists or ankles. The mother wears a bracelet which contains the same information. Identification is done before the baby leaves the delivery room or birthing room to avoid any mix- up in identity.

The Apgar Scale