Chapter 4: The Birth of a Child

Patient Story

Mary and Joe are expecting their first baby. The pregnancy has been without complications; routine prenatal screens and ultrasounds have been negative including the screen for Mary’s Group B Streptococcal (GBS) status, the Quad screen for fetal anomalies and cystic fibrosis carrier status. Mary is happy to report strong fetal movements. One week before her due date Mary experiences strong contractions. She is admitted in active labor, membranes rupture spontaneously within 2 hours after arrival in the hospital. Labor progresses uneventfully, pain relief is provided by epidural anesthesia. Ten hours later a vigorous baby girl is born. The only intervention provided for resuscitation is drying followed by skin-to-skin placement on mother’s chest for bonding. Initial physiologic cyanosis is resolved by 5 minutes of life (Figure 4-1). APGAR scores of 8 at 1 min and 9 at 5 min are assigned. Her weight shows that she is appropriate for gestational age. Erythromycin eye ointment is applied to both eyes for prophylaxis of ophthalmia neonatorum, an injection of Vitamin K intramuscularly is given for prophylaxis of hemorrhagic disease of the newborn. Mary chooses to breastfeed that is initiated shortly after delivery with the aid of a lactation consultant. Over the next couple of days, the newborn is breastfeeding about 10 times a day, voiding several times a day and has passed her first meconium stool by 14 hours of life. On day of life # 2 she has lost 6 percent of her birthweight and appears mildly jaundiced. A bilirubin level shows a value within the physiologic range. She is discharged at about 50 hours of life with her mother and a follow-up visit with her pediatrician is arranged for 2 days after discharge.

Epidemiology

• According to the Center for Disease Control,¹ in the US in 2011 there were:

  • a total of 3,953,593 births recorded.

  • 32.8 percent of infants delivered by Cesarean Section.

  • 11.72 percent of infants preterm.

  • 8.1 percent of low birthweight (<2500g).

• The neonatal mortality rate in 2011 was 4.04 neonatal deaths/1,000 live births/year, resulting in ca. 24,000 deaths per year.²

• The leading causes of neonatal deaths are preterm related (ca. 35%) and due to congenital malformations, most commonly heart defects.³

• Overall, 3 percent of all infants in the US are born with a major structural or genetic birth defect.⁴

• Ten percent of newborns require some degree of assistance in the delivery room; less than 1 percent require extensive resuscitation measures.⁵

Etiology and Pathophysiology

• A baby’s due date (Estimated date of Confinement [EDC]) is calculated at 40 weeks after the Last Menstrual Period (LMP).

• A baby born ...