Chapter Introduction
CHAPTER 4
Prenatal Development and Birth
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What Will You Know?
When do the most important parts of the fetus form? Brain development occurs in every prenatal month, but these middle three months are especially crucial. The entire central nervous system becomes responsive during mid–pregnancy, beginning to regulate basic body functions such as breathing and sucking. Advances in neurological functioning at the end of this trimester allow the fetus to reach the age of viability, the point of development when a fetus born far too early can become a baby who is able to survive.
Does medical assistance safeguard or impede the birth process? In the United States, the rate of cesareans rose between 1996 and 2008 (from 21 percent to 34 percent) before stabilizing. Cesareans have many advantages for doctors and hospitals (easier to schedule, quicker, and more profitable). One reason for the rise in c–sections is that modern medicine can eliminate pain in the lower half of the body while keeping the mother awake. One woman named Resch had a cesarean because her fetus was in a breech position (buttocks first, not head first). Resch felt “a lot of rough pushing and pulling” and ”a painless suction sensation” as if her body were “a tar pit the baby was wrestled from.” She heard the doctor say to the resident: “Hold her up by the hips,” and Resch peered down. She saw her daughter for the first time, wet and squirming... Resch's husband held the baby next to Resch's cheek. Resch felt “overwhelmed by emotions. . . joy, awe, anxiety, relief, surprise.” She gave thanks for her healthy baby, and for modern obstetrical care. The disadvantages appear later. C–sections increase medical complications after birth and reduce breast–feeding. By age 3, children born by cesarean have double the rate of childhood obesity: 16 percent compared to 8 percent. The reason may be that babies delivered vaginally have beneficial bacteria in their gut but those delivered surgically do not.
Why do substances and circumstances sometimes harm the fetus and sometimes have no impact? A number of factors affect whether or not substances and circumstances harm the fetus. These include critical timing (a period when a substance is most likely to harm a fetus), dose or frequency of exposure, and genetic vulnerability.
If tiny newborns survive, are they still affected by low birthweight years later? Longitudinal research from many nations finds that children who were at the extremes of SGA or preterm have many neurological problems in middle childhood, including smaller brain volume, lower IQs, and behavioral difficulties. Even in adulthood, risks persist: Adults who were LBW are more likely to develop diabetes and heart disease, partly because they are more often obese.
Why do some mothers suffer from postpartum depression, and how does that affect the baby? When the level of birth hormones decreases, between 8 and 15 percent of women experience postpartum depression, a sense of inadequacy and sadness. With postpartum depression, baby care (feeding, diapering, bathing) feels very burdensome. The newborn's cry may not compel the mother to carry and nurse her infant. Instead, the mother may have thoughts of neglecting or abusing the infant, thoughts so terrifying that she is afraid of herself. The first sign that something is amiss may be euphoria after birth. A new mother may be unable to sleep, to stop talking, or to push aside irrational worries. Some of this behavior is normal, but family members and medical personnel need to be alert to the mother's emotions. After the initial high, severe depression may set in, with a long–term impact on the child. But postpartum depression is not due to hormonal changes alone. From a developmental perspective, some causes of postpartum depression (such as financial stress) predate the pregnancy; others (such as marital problems) occur during pregnancy; others correlate with birth (especially if the mother is alone and imagined a different birth than actually occurred); and still others are specific to the particular infant (such as health, feeding, or sleeping problems). Successful breast–feeding mitigates maternal depression, one of the many reasons a lactation consultant is an important part of the new mother's support team.
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Germinal: The First 14 Days Embryo: From the Third Through the Eighth Week Fetus: From the Ninth Week Until Birth
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The Newborn’s First Minutes
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a view from science: Conflicting Advice opposing perspectives: “What Do People Live to Do?” Complications During Birth
Low Birthweight: Causes and Consequences Consequences of Low Birthweight -
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The scientific study of human development is not only about how individuals change over time, it is about how contexts and cultures change over time. Historical change—Bronfenbrenner’s chronosystem—is dramatically apparent in prenatal development and childbirth. If your knowledge of these comes from a high school biology class, or from your mother’s experience with you, get ready for surprises.
My daughter Elissa recently had her second child. She and her husband were together with the midwife in the labor room of the Birthing Center; I was with Asa, age 5, in the family room. Periodically Asa ran down the hall to see his parents. Usually the midwife let us come in, and Elissa smiled and asked him how he was doing. Sometimes we had to wait for a minute. Then, contraction over, mother and son smiled at each other again.
When the baby was born, the nurse came to tell us, “There’s a new person who wants to meet you.” Asa said, “Let me put this last Lego piece in.” He did, and brought his new creation to show his parents, who introduced him to his brother, sucking on his mother’s breast. Six hours later, the whole family was home.
The contrast between this 2014 birth and Elissa’s own arrival is stark. Back then, midwives were banned from my New York City hospital. Fathers were relegated to waiting rooms, as my husband, Martin, had been for our first two babies. Newly empowered by feminism, I convinced my board-certified obstetrician to let Martin witness birth. He wept when he held her, wet and wide-eyed, moments old. Then she was wiped, weighed, wrapped, and wheeled away. The nurses did not let me hold my daughter until she was 24 hours old. They said that I had no milk, that I needed rest, that my baby was tired, too. Wrong, wrong, wrong.
On day two, Martin brought our older children to visit. They were not permitted on the maternity floor, so they could not view their sister through the nursery glass. But I could hobble down to a special room to greet them. That was an innovation: Formerly no visitors under age 12 could set foot in the hospital.
On day three, I was breast-feeding and talking on the phone when an aide came to take Elissa back to the nursery. She scolded me.
“Hang up that phone. When you nurse, you must give your baby undivided attention.”
Wrong. She was old-fashioned; I knew better. I had nursed Bethany and Rachel while setting the table, stirring a pot, turning pages, and, of course, holding a phone. I was a pioneer, unlike that aide. I was riding the wave of liberation that was moving millions of women forward toward a brighter, fairer, unisex future.
Now I am the old-fashioned one. My daughter and her husband made dozens of decisions about this pregnancy and birth that I never imagined possible.
This chapter describes what we now know about prenatal growth and birth, and some of the vast differences from one era, one culture, even one family to another. Possible harm is noted: causes and consequences of diseases, malnutrition, drugs, pollution, stress, and so on, from the earliest days of life. Fathers, particularly, have become more active partners, while all of us—medical professionals, governments, and family members—affect the early life of each developing person. This chapter will help us do our part.