Psychology Paper

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Emotional Stress When women experience severe emotional stress during pregnancy, their babies are at risk for a wide variety of difficulties. Intense anxiety—especially during the first two trimesters—is associated with higher rates of miscarriage, prematurity, low birth weight, infant respiratory and digestive illnesses, colic (persistent infant crying), sleep disturbances, and irritability during the child’s first three years (Dunkel-Shetter&Lobel, 2012; Field, 2011; Lazinski, Shea, & Steiner, 2008). Prenatal stressors consistently found to impair infant physical and psychological well-being include chronic strain due to poverty, neighborhood crime, or homelessness; major negative life events such as divorce or death of a family member; community-wide disasters such as earthquakes or terrorist attacks; and fears specific to pregnancy and childbirth, including anxiety about the health and survival of the baby and oneself. How can maternal stress affect the developing organism? TAKE A MOMENT… To understand this process, list the changes you sensed in your own body the last time you were under stress. When we experience fear and anxiety, stimulant hormones released into our bloodstream—such as epinephrine (adrenaline) and cortisol, known as the “flight or fight” hormones—cause us to be “poised for action.” Large amounts of blood are sent to parts of the body involved in the defensive response—the brain, the heart, and the muscles in the arms, legs, and trunk. Blood flow to other organs, including the uterus, is reduced. As a result, the fetus is deprived of a full supply of oxygen and nutrients. Maternal stress hormones also cross the placenta, causing a dramatic rise in fetal stress hormones (evident in the amniotic fluid) and, therefore, in fetal heart rate, blood pressure, blood glucose, and activity level (Kinsella & Monk, 2009; Weinstock, 2008). Excessive fetal stress may permanently alter fetal neurological functioning, thereby heightening stress reactivity in later life. In several studies, infants and children of mothers who experienced severe prenatal anxiety displayed cortisol levels that were either abnormally high or abnormally low, both of which signal impaired physiological capacity to manage stress. Consistent with these findings, such children are more upset than their agemates when faced with novel or challenging experiences—effects that persist into adolescence and early adulthood (Entringer et al., 2009; Van den Bergh et al., 2008). Furthermore, maternal emotional stress during pregnancy predicts weakened immune system functioning and increased susceptibility to infectious disease in childhood (Nielsen et al., 2011). It is also associated with diverse negative behavioral outcomes, including anxiety, short attention span, anger, aggression, overactivity, and lower intelligence test scores, above and beyond the impact of other risks, such as maternal smoking during pregnancy, low birth weight, postnatal maternal anxiety, and low SES (Loomans et al., 2011; Monk, Georgieff, &Osterholm, 2013). But stress-related prenatal complications are greatly reduced when mothers have partners, other family members, and friends who offer social support (Bloom et al., 2013; Luecken et al., 2013). The relationship of social support to positive pregnancy outcomes and subsequent child development is particularly strong for economically disadvantaged women, who often lead highly stressful lives (see the Social Issues: Health box on page 114). Look and Listen List prenatal environmental factors that can compromise later academic performance and social adjustment. Ask several adults who hope someday to be parents to explain what they know about each factor. How great is their need for prenatal education? RH Factor Incompatibility When inherited blood types of mother and fetus differ, serious problems sometimes result. The most common cause of these difficulties is Rh factor incompatibility. When the mother is Rh-negative (lacks the Rh blood protein) and the father is Rh-positive (has the protein), the baby may inherit the father’s Rh-positive blood type. (Because Rh-positive blood is dominant and Rh-negative blood is recessive, the chances are good that the baby will be Rh-positive.) If even a little of a fetus’s Rh-positive blood crosses the placenta into the Rh-negative mother’s bloodstream, she begins to form antibodies to the foreign Rh protein. If these enter the fetus’s system, they destroy red blood cells, reducing the oxygen supply to organs and tissues. Intellectual disability, miscarriage, heart damage, and infant death can occur. It takes time for the mother to produce Rh antibodies, so firstborn children are rarely affected. The danger increases with each additional pregnancy. Fortunately, Rh incompatibility can be prevented in most cases. After the birth of each Rh-positive baby, Rh-negative mothers are routinely given a vaccine to prevent the buildup of antibodies. In emergency cases, blood transfusions can be performed immediately after delivery or, if necessary, even before birth. Social Issues: Health The Nurse–Family Partnership: Reducing Maternal Stress and Enhancing Child Development Through Social Support At age 17, Denise—an unemployed high-school dropout living with her disapproving parents—gave birth to Tara. Having no one to turn to for help during pregnancy and beyond, Denise felt overwhelmed and anxious much of the time. Tara was premature and cried uncontrollably, slept erratically, and suffered from frequent minor illnesses throughout her first year. When she reached school age, she had trouble keeping up academically, and her teachers described her as distractible, unable to sit still, angry, and uncooperative. The Nurse–Family Partnership—currently implemented in hundreds of counties across 43 U.S. states, in six tribal communities, in the U.S. Virgin Islands, and internationally in Australia, Canada, the Netherlands, and the United Kingdom—is a voluntary home visiting program for first-time, low-income expectant mothers like Denise. Its goals are to reduce pregnancy and birth complications, promote competent early caregiving, and improve family conditions, thereby protecting children from lasting adjustment difficulties. A registered nurse visits the home weekly during the first month after enrollment, twice a month during the remainder of pregnancy and through the middle of the child’s second year, and then monthly until age 2. In these sessions, the nurse provides the mother with intensive social support—a sympathetic ear; assistance in accessing health and other community services and the help of family members (especially fathers and grandmothers); and encouragement to finish high school, find work, and engage in future family planning. To evaluate the program’s effectiveness, researchers randomly assigned large samples of mothers at risk for high prenatal stress (due to teenage pregnancy, poverty, and other negative life conditions) to nurse-visiting or comparison conditions (just prenatal care, or prenatal care plus infant referral for developmental problems). Families were followed through their child’s school-age years and, in one experiment, into adolescence (Kitzman et al., 2010; Olds et al., 2004, 2007; Rubin et al., 2011). As kindergartners, Nurse–Family Partnership children obtained higher language and intelligence test scores. And at both ages 6 and 9, children of home-visited mothers in the poorest mental health during pregnancy exceeded comparison children in academic achievement and displayed fewer behavior problems. Furthermore, from their baby’s birth on, home-visited mothers were on a more favorable life course: They had fewer subsequent births, longer intervals between their first and second births, more frequent contact with the child’s father, more stable intimate partnerships, less welfare dependence, and a greater sense of control over their lives—key factors in reducing subsequent prenatal stress and in protecting children’s development. Perhaps for these reasons, adolescent children of home-visited mothers continued to be advantaged in academic achievement and reported less alcohol and drug use than comparison-group agemates. Other findings revealed that professional nurses, compared with trained paraprofessionals, were far more effective in preventing outcomes associated with prenatal stress, including high infant fearfulness to novel stimuli and delayed mental development (Olds et al., 2002). Nurses were probably more proficient in individualizing program guidelines to fit the strengths and challenges faced by each family. They also might have had unique legitimacy as experts in the eyes of stressed mothers, more easily convincing them to take steps to reduce pregnancy complications that can trigger persisting developmental problems—such as those Tara displayed. The Nurse–Family Partnership provides a first-time, low-income mother with regular home visits from a registered nurse, who offers social support and help in accessing community services. As a result, this child has a considerably better chance of developing favorably. COURTESY OF NURSE–FAMILY PARTNERSHIP The Nurse–Family Partnership is highly cost-effective (Dawley, Loch, &Bindrich, 2007). For each $1 spent, it saves more than $5 in public spending on pregnancy complications, preterm births, and child and youth learning and behavior problems. 
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Stage 1: Dilation and Effacement of the Cervix

Stage 1 is the longest, lasting an average of 12 to 14 hours with a first birth and 4 to 6 hours with later births. Dilation and effacement of the cervix take place—that is, as uterine contractions gradually become more frequent and powerful, they cause the cervix to open (dilate) and thin (efface), forming a clear channel from the uterus into the birth canal, or vagina. The uterine contractions that open the cervix are forceful and regular, starting out 10 to 20 minutes apart and lasting about 15 to 20 seconds. Gradually, they get closer together, occurring every 2 to 3 minutes, and become stronger, persisting for as long as 60 seconds.

During this stage, Yolanda could do nothing to speed up the process. Jay held her hand, provided sips of juice and water, and helped her get comfortable. Throughout the first few hours, Yolanda walked, stood, or sat upright. As the contractions became more intense, she leaned against pillows or lay on her side.

The climax of Stage 1 is a brief phase called transition, in which the frequency and strength of contractions are at their peak and the cervix opens completely. Although transition is the most uncomfortable part of childbirth, it is especially important that the mother relax. If she tenses or bears down with her muscles before the cervix is completely dilated and effaced, she may bruise the cervix and slow the progress of labor.

Stage 2: Delivery of the Baby

In Stage 2, which lasts about 50 minutes for a first baby and 20 minutes in later births, the infant is born. Strong contractions of the uterus continue, but the mother also feels a natural urge to squeeze and push with her abdominal muscles. As she does so with each contraction, she forces the baby down and out.

Between contractions, Yolanda dozed lightly. When the doctor announced that the baby’s head was crowning—the vaginal opening had stretched around the entire head—Yolanda felt renewed energy; she knew that soon the baby would arrive. Quickly, with several more pushes, Joshua’s forehead, nose, and chin emerged, then his upper body and trunk. The doctor held him up, wet with amniotic fluid and still attached to the umbilical cord. As air rushed into his lungs, Joshua cried. When the umbilical cord stopped pulsing, it was clamped and cut. A nurse placed Joshua on Yolanda’s chest, where she and Jay could see, touch, and gently talk to him. Then the nurse wrapped Joshua snugly, to help with temperature regulation.

Stage 3: Birth of the Placenta

Stage 3 brings labor to an end. A few final contractions and pushes cause the placenta to separate from the wall of the uterus and be delivered in about 5 to 10 minutes. Yolanda and Jay were surprised at the large size of the thick 1½-pound red-gray organ, which had taken care of Joshua’s basic needs for the previous nine months.

The Baby’s Adaptation to Labor and Delivery

At first glance, labor and delivery seem like a dangerous ordeal for the baby. The strong contractions of Yolanda’s uterus exposed Joshua’s head to a great deal of pressure, and they squeezed the placenta and the umbilical cord repeatedly. Each time, Joshua’s supply of oxygen was temporarily reduced.

Fortunately, healthy babies are equipped to withstand these traumas. The force of the contractions intensifies the baby’s production of stress hormones. Unlike during pregnancy, when excessive stress endangers the fetus (see Chapter 3), during childbirth high levels of infant cortisol and other stress hormones are adaptive. They help the baby withstand oxygen deprivation by sending a rich supply of blood to the brain and heart (Gluckman, Sizonenko, & Bassett, 1999). And as noted earlier, they prepare the newborn’s lungs to breathe. Finally, stress hormones arouse the infant into alertness. Joshua was born wide-awake, ready to interact with the surrounding world.

The Newborn Baby’s Appearance

Parents are often surprised at the odd-looking newborn—a far cry from the storybook image they may have had in their minds. The average newborn is 20 inches long and 7½ pounds in weight; boys tend to be slightly longer and heavier than girls. The head is large in comparison to the trunk and legs, which are short and bowed. Proportionally, if your head were as large as that of a newborn infant, you would be balancing something about the size of a watermelon between your shoulders! This combination of a large head (with its well-developed brain) and a small body means that human infants learn quickly in the first few months of life. But unlike most other mammals, they cannot get around on their own until much later.


To accommodate the well-developed brain, a newborn’s head is large in relation to the trunk and legs. This newborn’s body readily turns pink as she takes her first few breaths.
LILIAN WILSON/RISER/GETTY IMAGES
Even though newborn babies may not match parents’ idealized image, some features do make them attractive (Luo, Li, & Lee, 2011). Their round faces, chubby cheeks, large foreheads, and big eyes make adults feel like picking them up and cuddling them.

Assessing the Newborn’s Physical Condition: The Apgar Scale

Infants who have difficulty making the transition to life outside the uterus must be given special help at once. To assess the newborn’s physical condition quickly, doctors and nurses use the Apgar Scale. As Table 4.1 shows, a rating of 0, 1, or 2 on each of five characteristics is made at 1 minute and again at 5 minutes after birth. A combined Apgar score of 7 or better indicates that the infant is in good physical condition. If the score is between 4 and 6, the baby requires assistance in establishing breathing and other vital signs. If the score is 3 or below, the infant is in serious danger and requires emergency medical attention. Two Apgar ratings are given because some babies have trouble adjusting at first but do quite well after a few minutes (Apgar, 1953).

Table 4.1 The Apgar Scale
Source: Apgar, 1953.
SCORE
SIGNa 0 1 2
aTo remember these signs, you may find it helpful to use a technique in which the original labels are reordered and renamed as follows: color = Appearance; heart rate = Pulse; reflex irritability = Grimace; muscle tone = Activity; and respiratory effort = Respiration. Together, the first letters of the new labels spell Apgar.

bThe skin tone of nonwhite babies makes it difficult to apply the “pink” color criterion. However, newborns of all races can be rated for pinkish glow resulting from the flow of oxygen through body tissues.
Heart rate No heartbeat Under 100 beats per minute 100 to 140 beats per minute
Respiratory effort No breathing for 60 seconds Irregular, shallow breathing Strong breathing and crying
Reflex irritability (sneezing, coughing, and grimacing) No response Weak reflexive response Strong reflexive response
Muscle tone Completely limp Weak movements of arms and legs Strong movements of arms and legs
Colorb Blue body, arms, and legs Body pink with blue arms and legs Body, arms, and legs completely pink
Ask Yourself
REVIEW Name and briefly describe the three stages of labor.
CONNECT Contrast the positive impact of the baby’s production of high levels of stress hormones during childbirth with the negative impact of severe maternal stress on the fetus, discussed on page 
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When mothers are upright, labor is slightly shorter because contractions are stronger and pushing is more effective. The baby benefits from a richer supply of oxygen because blood flow to the placenta is increased, and fewer instances of infant heartbeat irregularities occur. Because the mother can see the delivery, she can work with the doctor or midwife, adjusting her pushing to ensure that the baby’s head and shoulders emerge slowly, which reduces the chances of tearing the mother’s tissues and, thus, the need for an episiotomy (incision that increases the size of the vaginal opening). Compared with those who give birth lying on their backs, women who choose an upright position are less likely to use pain-relieving medication or to have instrument-assisted deliveries (Gupta, Hofmeyr, &Shehmar, 2012; Romano & Lothian, 2008).


After a home birth, the midwife and a lay attendant provide support to the new mother. For healthy women attended by a well-trained doctor or midwife, home birth is as safe as hospital birth.
ANDERSEN ROSS/BRAND X PICTURES/GETTY IMAGES
In another increasingly popular method, water birth, the mother sits in a warm tub of water, which supports her weight, relaxes her, and provides her with the freedom to move into any position she finds most comfortable. Among mothers at low risk for birth complications, water birth is associated with reduced maternal stress, shorter labor, lower episiotomy rate, and greater likelihood of medication-free delivery than both back-lying and seated positions (American Association of Birth Centers, 2014; Cluett& Burns, 2013). As long as water birth is carefully managed by skilled health professionals, it poses no additional risk of infection or safety to mothers or babies.

Home Delivery

Home birth has always been popular in certain industrialized nations, such as England, the Netherlands, and Sweden. The number of American women choosing to have their babies at home rose during the 1970s and 1980s but remains small, at less than 1 percent (Martin et al., 2013). Although some home births are attended by doctors, many more are handled by certified nurse-midwives, who have degrees in nursing and additional training in childbirth management.

The joys and perils of home delivery are well illustrated by the story that Don, a father of four, told us. “Our first child was delivered in the hospital,” he said. “Even though I was present, Kathy and I found the atmosphere to be rigid and insensitive. We wanted a warmer, more personal birth environment.” With a nurse-midwife’s coaching, Don delivered their second child, Cindy, at their farmhouse, 3 miles out of town. Three years later, when Kathy went into labor with Marnie, a heavy snowstorm prevented the midwife from reaching the house on time, so Don delivered the baby alone. The birth was difficult, and Marnie failed to breathe for several minutes. With great effort, Don managed to revive her. The frightening memory of Marnie’s limp, blue body convinced Don and Kathy to return to the hospital to have their last child. By then, the hospital’s birth practices had changed, and the event was a rewarding one for both parents.

Don and Kathy’s experience raises the question: Is it just as safe to give birth at home as in a hospital? For healthy women who are assisted by a well-trained doctor or midwife, it seems so because complications rarely occur (Fullerton, Navarro, & Young, 2007; Wax, Pinette, &Cartin, 2010). However, if attendants are not carefully trained and prepared to handle emergencies, the likelihood of infant disability and death is high. When mothers are at risk for any kind of complication, the appropriate place for labor and delivery is the hospital, where life-saving treatment is available. 
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Preterm versus Small-for-Date Infants
Although preterm and low-birth-weight infants face many obstacles to healthy development, most go on to lead normal lives; about half of those born at 23 to 24 weeks gestation and weighing only a couple of pounds at birth have no disability (refer again to Figure 4.3). To better understand why some babies do better than others, researchers divide them into two groups. Preterm infants are born several weeks or more before their due date. Although they are small, their weight may still be appropriate, based on time spent in the uterus. Small-for-date infants are below their expected weight considering length of the pregnancy. Some small-for-date infants are actually full-term. Others are preterm babies who are especially underweight.

Small-for-date infants—especially those who are also preterm—usually have more serious problems. During the first year, they are more likely to die, catch infections, and show evidence of brain damage. By middle childhood, they are smaller in stature, have lower intelligence test scores, are less attentive, achieve more poorly in school, and are socially immature (Katz et al., 2013; Sullivan et al., 2008; Wilson-Ching et al., 2013).

Small-for-date infants probably experienced inadequate nutrition before birth. Perhaps their mothers did not eat properly, the placenta did not function normally, or the babies themselves had defects that prevented them from growing as they should. In some of these babies, an abnormally functioning placenta permitted ready transfer of stress hormones from mother to fetus. Consequently, small-for-date infants are especially likely to suffer from neurological impairments that permanently weaken their capacity to manage stress (Osterholm, Hostinar, & Gunnar, 2012). Severe stress, in turn, heightens their susceptibility to later physical and psychological health problems.

Even among preterm newborns whose weight is appropriate for length of pregnancy, just 7 to 14 more days—from 34 to 35 or 36 weeks—greatly reduces rates of illness, costly medical procedures, and lengthy hospital stays (although they need greater medical intervention than full-term babies) (Ananth, Friedman, &Gyamfi-Bannerman, 2013). And despite being relatively low-risk for disabilities, a substantial number of 34-week preterms are below average in physical growth and mildly to moderately delayed in cognitive development in early and middle childhood (Morse et al., 2009; Stephens &Vohr, 2009). In an investigation of over 120,000 New York City births, babies born even 1 or 2 weeks early showed slightly lower reading and math scores at a third-grade follow-up than children who experienced a full-length prenatal period (Noble et al., 2012). These outcomes persisted even after controlling for other factors linked to achievement, such as birth weight and SES. Yet doctors often induce births several weeks preterm, under the misconception that these babies are developmentally “mature.”

Consequences for Caregiving
Imagine a scrawny, thin-skinned infant whose body is only a little larger than the size of your hand. You try to play with the baby by stroking and talking softly, but he is sleepy and unresponsive. When you feed him, he sucks poorly. During the short, unpredictable periods in which he is awake, he is usually irritable.

The appearance and behavior of preterm babies can lead parents to be less sensitive and responsive in caring for them. Compared to full-term infants, preterm babies—especially those who are very ill at birth—are less often held close, touched, and talked to gently. At times, mothers of these infants behave in an overly controlling fashion, resorting to interfering pokes and verbal commands in an effort to obtain a higher level of response from the baby (Feldman, 2007b; Forcada-Guex et al., 2006). This may explain why preterm babies as a group are at risk for child abuse.

Research reveals that distressed, emotionally reactive preterm infants are particularly susceptible to the effects of parenting quality: Among a sample of preterm 9-month-olds, the combination of infant negativity and angry or intrusive parenting yielded the highest rates of behavior problems at 2 years of age. But with warm, sensitive parenting, distressed preterm babies’ rates of behavior problems were the lowest (Poehlmann et al., 2011). When they are born to isolated, poverty-stricken mothers who cannot provide good nutrition, health care, and parenting, the likelihood of unfavorable outcomes increases. In contrast, parents with stable life circumstances and social supports usually can overcome the stresses of caring for a preterm infant (Ment et al., 2003). In these cases, even sick preterm babies have a good chance of catching up in development by middle childhood.

These findings suggest that how well preterm babies develop has a great deal to do with the parent–child relationship. Consequently, interventions directed at supporting both sides of this tie are more likely to help these infants recover.

Interventions for Preterm Infants
A preterm baby is cared for in a special Plexiglas-enclosed bed called an isolette. Temperature is carefully controlled because these infants cannot yet regulate their own body temperature effectively. To help protect the baby from infection, air is filtered before it enters the isolette. When a preterm infant is fed through a stomach tube, breathes with the aid of a respirator, and receives medication through an intravenous needle, the isolette can be very isolating indeed! Physical needs that otherwise would lead to close contact and other human stimulation are met mechanically.

Special Infant Stimulation

In proper doses, certain kinds of stimulation can help preterm infants develop. In some intensive care nurseries, preterm babies can be seen rocking in suspended hammocks or lying on waterbeds designed to replace the gentle motion they would have received while still in the mother’s uterus. Other forms of stimulation have also been used—an attractive mobile or a tape recording of a heartbeat, soft music, or the mother’s voice. These experiences promote faster weight gain, more predictable sleep patterns, and greater alertness (Arnon et al., 2006; Marshall-Baker, Lickliter, & Cooper, 1998).

Touch is an especially important form of stimulation. In baby animals, touching the skin releases certain brain chemicals that support physical growth—effects believed to occur in humans as well. When preterm infants were gently massaged several times each day in the hospital, they gained weight faster and, at the end of the first year, were more advanced in mental and motor development than preterm babies not given this stimulation (Field, 2001; Field, Hernandez-Reif, & Freedman, 2004).


Top photo: A father in El Salvador uses skin-to-skin “kangaroo care” with his infant as part of a hospital program that teaches parents techniques for promoting survival and development in preterm and underweight babies. Bottom photo: In Western nations, kangaroo care may be used to supplement hospital intensive care. Here, a U.S. mother engages in the technique with her fragile newborn.
In developing countries where hospitalization is not always possible, skin-to-skin “kangaroo care” is the most readily available intervention for promoting the survival and recovery of preterm babies. It involves placing the infant in a vertical position between the mother’s breasts or next to the father’s chest (under the parent’s clothing) so the parent’s body functions as a human incubator. Kangaroo care offers fathers a unique opportunity to increase their involvement in caring for the preterm newborn. Because of its many physical and psychological benefits, the technique is used often in Western nations as a supplement to hospital intensive care.

Kangaroo skin-to-skin contact fosters improved oxygenation of the baby’s body, temperature regulation, sleep, breastfeeding, alertness, and infant survival (Conde-Agudelo, Belizan, & Diaz-Rossello, 2011; Kaffashi et al., 2013; Lawn et al., 2010). In addition, the kangaroo position provides the baby with gentle stimulation of all sensory modalities: hearing (through the parent’s voice), smell (through proximity to the parent’s body), touch (through skin-to-skin contact), and visual (through the upright position). Mothers and fathers practicing kangaroo care feel more confident about caring for their fragile babies, interact more sensitively and affectionately, and feel more attached to them (Dodd, 2005; Feldman, 2007a).

Together, these factors may explain why preterm babies given many hours of kangaroo care in their early weeks, compared to those given little or no such care, are more likely to explore novel toys and score higher on measures of mental and motor development during the first year (Bera et al., 2014; Feldman, 2007a). Because of its diverse benefits, most U.S. hospital nurseries now offer kangaroo care to parents and preterm newborns.

Training Parents in Infant Caregiving Skills

Interventions that support parents of preterm infants generally teach them about the infant’s characteristics and promote caregiving skills. For parents with the economic and personal resources to care for a preterm infant, just a few sessions of coaching in recognizing and responding to the baby’s needs are linked to enhanced parent–infant interaction, reduced infant crying and improved sleep, more rapid language development in the second year, and steady gains in mental test performance that equal those of full-term children by middle childhood (Achenbach, Howell, & Aoki, 1993; Newnham, Milgrom, &Skouteris, 2009).

When preterm infants live in stressed, economically disadvantaged households, long-term intensive intervention is necessary (Guralnick, 2012). In the Infant Health and Development Program, preterm babies born into poverty received a comprehensive intervention. It combined medical follow-up, weekly home visits beginning soon after hospital discharge in which mothers received training in infant care and everyday problem solving, and cognitively stimulating child care from 1 to 3 years of age. More than four times as many intervention children as no-intervention controls (39 versus 9 percent) were within normal range at age 3 in intelligence, psychological adjustment, and physical growth (Bradley et al., 1994). In addition, mothers in the intervention group were more affectionate and more often encouraged play and cognitive mastery in their children—one reason their 3-year-olds may have been developing so favorably (McCarton, 1998).

At ages 5 and 8, children who had attended the child-care program regularly—for more than 350 days over the three-year period—continued to show better intellectual functioning. The more they attended, the higher they scored, with greater gains among those whose birth weights were higher—between 4½ and 5½ pounds (2,001 to 2,500 grams) (see Figure 4.4). In contrast, children who attended only sporadically gained little or even lost ground (Hill, Brooks-Gunn, &Waldfogel, 2003). A follow-up at age 18 revealed persisting benefits for the higher-birth-weight participants: They remained advantaged over controls in academic achievement, and they also engaged in fewer risky behaviors such as unprotected sexual activity and alcohol and drug use (McCormick et al., 2006).


Figure 4.4 Influence of intensity of early intervention for low-income, preterm babies on intellectual functioning at age 8.
Infants born preterm received cognitively stimulating child care from 1 through 3 years of age. Those who attended the program sporadically gained little in intellectual functioning (heavier-weight babies) or lost ground (lighter-weight babies). The more often children attended, the greater their intellectual gains. Heavier babies consistently gained more than light babies. But boosting the intensity of intervention above 400 days led to a dramatic increase in the performance of the light-weight group.
(Adapted from Hill, Brooks-Gunn, &Waldfogel, 2003.)
These findings confirm that babies who are both preterm and economically disadvantaged require intensive intervention. And special strategies, such as extra adult–child interaction both at home and in infant–toddler and early childhood programs, may be necessary to achieve lasting changes in children with the lowest birth weights.

Very Low Birth Weight, Environmental Advantages, and Long-Term Outcomes
Although very low-birth-weight individuals often have lasting problems, in a Canadian study, young adults who weighed between 1 and 2.2 pounds (500 to 1,000 grams) at birth were doing well in overall quality of life (Saigal et al., 2006). At 22 to 25 years of age, they resembled normal-birth-weight individuals in educational attainment, rates of marriage and parenthood, and (for those who had no neurological or sensory impairments) employment status. What explains these excellent outcomes? Researchers believe that home, school, and societal advantages are largely responsible (Hack & Klein, 2006). Most participants in this study were reared in two-parent middle-SES homes, attended good schools where they received special services, and benefited from Canada’s universal health care system.
The Newborn Baby’s Capacities

4.6 Describe the newborn baby’s reflexes and states of arousal, including sleep characteristics and ways to soothe a crying baby.
4.7 Describe the newborn baby’s sensory capacities.
4.8 Why is neonatal behavioral assessment useful?
Newborn infants have a remarkable set of capacities that are crucial for survival and for evoking adult attention and care. In relating to the physical and social world, babies are active from the very start.

Reflexes

A reflex is an inborn, automatic response to a particular form of stimulation. Reflexes are the newborn baby’s most obvious organized patterns of behavior. As Jay placed Joshua on a table in the classroom, we saw several. When Jay bumped the side of the table, Joshua reacted by flinging his arms wide and bringing them back toward his body. As Yolanda stroked Joshua’s cheek, he turned his head in her direction. When she put her finger in Joshua’s palm, he grabbed on tightly. TAKE A MOMENT… Look at Table 4.2 on page 142 and see if you can name the newborn reflexes that Joshua displayed. Then let’s consider the meaning and purpose of these curious behaviors.

Adaptive Value of Reflexes
Some reflexes have survival value. The rooting reflex helps a breastfed baby find the mother’s nipple. Babies display it only when hungry and touched by another person, not when they touch themselves (Rochat&Hespos, 1997). And if sucking were not automatic, our species would be unlikely to survive for a single generation! At birth, babies adjust their sucking pressure to how easily milk flows from the nipple (Craig & Lee, 1999). The swimming reflex helps a baby who is accidentally dropped into water stay afloat, increasing the chances of retrieval by the caregiver.

Table 4.2 Some Newborn Reflexes
Sources: Knobloch&Pasamanick, 1974; Prechtl&Beintema, 1965; Thelen, Fisher, & Ridley-Johnson, 1984.
REFLEX STIMULATION RESPONSE AGE OF DISAPPEARANCE FUNCTION
aPlacing infants in a pool of water is dangerous. See discussion on the following page.
Eye blink Shine bright light at eyes or clap hand near head. Infant quickly closes eyelids. Permanent Protects infant from strong stimulation
Rooting Stroke cheek near corner of mouth Head turns toward source of stimulation. 3 weeks (becomes voluntary head turning at this time) Helps infant find the nipple
Sucking Place finger in infant’s mouth. Infant sucks finger rhythmically. Replaced by voluntary sucking after 4 months Permits feeding
Swimminga Occurs when infant is face down in pool of water. Baby paddles and kicks in swimming motion. 4–6 months Helps infant survive if dropped into water
Moro Hold infant horizontally on back and let head drop slightly, or produce a sudden loud sound against surface supporting infant. Infant makes an “embracing” motion by arching back, extending legs, throwing arms outward, and then bringing arms in toward the body 6 months In human evolutionary past, may have helped infant cling to mother
Palmar grasp Place finger in infant’s hand and press against palm Spontaneous grasp of finger 3–4 months Prepares infant for voluntary grasping
Tonic neck Turn baby’s head to one side while infant is lying awake on back Infant lies in a “fencing position.” One arm is extended in front of eyes on side to which head is turned, other arm is flexed 4 months May prepare infant for voluntary reaching
Stepping Hold infant under arms and permit bare feet to touch a flat surface Infant lifts one foot after another in stepping response 2 months in infants who gain weight quickly; sustained in lighter infants Prepares infant for voluntary walking
Babinski Stroke sole of foot from toe toward heel Toes fan out and curl as foot twists in 8–12 months Unknown

The palmar grasp reflex is so strong during the first week after birth that many infants can use it to support their entire weight.
© LAURA DWIGHT PHOTOGRAPHY
Other reflexes probably helped babies survive during our evolutionary past. For example, the Moro, or “embracing,” reflex is believed to have helped infants cling to their mothers when they were carried about all day (Kessen, 1967). If the baby happened to lose support, the reflex caused the infant to embrace and, along with the palmar grasp reflex (so strong during the first week that it can support the baby’s entire weight), regain its hold on the mother’s body.

Several reflexes help parents and infants establish gratifying interaction. A baby who searches for and successfully finds the nipple, sucks easily during feedings, and grasps when her hand is touched encourages parents to respond lovingly and feel competent as caregivers. Reflexes can also help parents comfort the baby because they permit infants to control distress and amount of stimulation. For example, on short trips with Joshua to the grocery store, Yolanda brought along a pacifier. If he became fussy, sucking helped quiet him until she could feed, change, or hold him.

Reflexes and the Development of Motor Skills
A few reflexes form the basis for complex motor skills that will develop later. For example, the tonic neck reflex may prepare the baby for voluntary reaching. When infants lie on their backs in this “fencing position,” they naturally gaze at the hand in front of their eyes. The reflex may encourage them to combine vision with arm movements and, eventually, reach for objects (Knobloch&Pasamanick, 1974).

Certain reflexes—such as the palmar grasp, swimming, and stepping—drop out early, but the motor functions involved are renewed later. The stepping reflex, for example, looks like a primitive walking response. Unlike other reflexes, it appears in a wide range of situations—with 
The Transition to Parenthood

4.9 Describe typical changes in the family after the birth of a new baby, along with interventions that foster the transition to parenthood.
The early weeks after a new baby enters the family are full of profound changes. The mother needs to recover from childbirth and adjust to massive hormone shifts in her body. If she is breastfeeding, energies must be devoted to working out this intimate relationship. The father must become a part of this new threesome while supporting the mother in her recovery. At times, he may feel ambivalent about the baby, who constantly demands and gets the mother’s attention.

While all this is going on, the tiny infant is assertive about his urgent physical needs, demanding to be fed, changed, and comforted at odd times of the day and night. The family schedule becomes irregular and uncertain, and parental sleep deprivation and consequent daytime fatigue is often a major challenge (Insana& Montgomery-Downs, 2012). Yolanda spoke candidly about the changes she and Jay experienced:

When we brought Joshua home, he seemed so small and helpless, and we worried about whether we would be able to take proper care of him. It took us 20 minutes to change the first diaper. I rarely feel rested because I’m up two to four times every night, and I spend a good part of my waking hours trying to anticipate Joshua’s rhythms and needs. If Jay weren’t so willing to help by holding and walking Joshua, I think I’d find it much harder.
Changes in the Family System

The demands of new parenthood—constant caregiving, added financial responsibilities, and less time for couples to devote to one another—usually cause the gender roles of husband and wife to become more traditional (Katz-Wise, Priess, & Hyde, 2010; Lawrence et al., 2010). This is true even for couples like Yolanda and Jay, who are strongly committed to gender equality and are used to sharing household tasks. Yolanda took a leave of absence from work, whereas Jay’s career continued as it had before. As a result, Yolanda spent more time at home with the baby, while Jay focused more on his provider role.

For most new parents, however, the arrival of a baby—though often associated with mild declines in relationship satisfaction and communication quality—does not cause significant marital strain. Marriages that are gratifying and supportive tend to remain so (Doss et al., 2009; Feeney et al., 2001). But troubled marriages usually become more distressed after a baby is born (Houts et al., 2008; Kluwer & Johnson, 2007). And when expectant mothers anticipate lack of partner support in parenting, their prediction generally becomes reality, yielding an especially difficult post-birth adjustment (Driver et al., 2012; McHale &Rotman, 2007). For some new parents, problems are severe (see the Biology and Environment box on the following page).

Violated expectations about division of labor in the home powerfully affect family well-being. In dual-earner marriages, the larger the difference between men’s and women’s caregiving responsibilities, the greater the decline in marital satisfaction after childbirth, especially for women—with negative consequences for parent–infant interaction. In contrast, sharing caregiving predicts greater parental happiness and sensitivity to the baby (McHale et al., 2004; Moller, Hwang, &Wickberg, 2008). An exception exists, however, for employed lower-SES women who endorse traditional gender roles. When their husbands help extensively with child care, these mothers tend to report more distress, perhaps because they feel disappointed at being unable to fulfill their desire to do most of the caregiving (Goldberg & Perry-Jenkins, 2003).

Postponing parenthood until the late twenties or thirties, as more couples do today, eases the transition to parenthood. Waiting permits couples to pursue occupational goals and gain life experience. Under these circumstances, men are more enthusiastic about becoming fathers and therefore more willing to participate. And women whose careers are well under way and whose marriages are happy are more likely to encourage their husbands to share housework and child care, which fosters fathers’ involvement (Lee & Doherty, 2007; Schoppe-Sullivan et al., 2008).

Biology and Environment Parental Depression and Child Development
About 8 to 10 percent of women experience chronic depression—mild to severe feelings of sadness and withdrawal that continue for months or years. Often, the beginnings of this emotional state cannot be pinpointed. In other instances, depression emerges or strengthens after childbirth but fails to subside as the new mother adjusts to hormonal changes in her body and gains confidence in caring for her baby. This is called postpartum depression.

Although it is less recognized and studied, fathers, too, experience chronic depression. About 3 to 5 percent of fathers report symptoms after the birth of a child (Madsen &Juhl, 2007; Thombs, Roseman, & Arthurs, 2010). Parental depression can interfere with effective parenting and seriously impair children’s development. As noted in Chapter 2, genetic makeup increases the risk of depressive illness, but social and cultural factors are also involved.

Maternal Depression
During Julia’s pregnancy, her husband, Kyle, showed so little interest in the baby that Julia worried that having a child might be a mistake. Then, shortly after Lucy was born, Julia’s mood plunged. She felt anxious and weepy, overwhelmed by Lucy’s needs, and angry at loss of control over her own schedule. When Julia approached Kyle about her own fatigue and his unwillingness to help with the baby, he snapped that she was overreacting. Julia’s childless friends stopped by just once to see Lucy but did not call again.

Julia’s depressed mood quickly affected her baby. In the weeks after birth, infants of depressed mothers sleep poorly, are less attentive to their surroundings, and have elevated levels of the stress hormone cortisol (Field, 1998). The more extreme the depression and the greater the number of stressors in a mother’s life (such as marital discord, little or no social support, and poverty), the more the parent–child relationship suffers (Simpson et al., 2003). Julia rarely smiled at, comforted, or talked to Lucy, who responded to her mother’s sad, vacant gaze by turning away, crying, and often looking sad or angry herself (Feldman et al., 2009; Field, 2011). Julia, in turn, felt guilty and inadequate, and her depression deepened. By age 6 months, Lucy showed symptoms common in babies of depressed mothers—delays in motor and mental development, an irritable mood, and attachment difficulties (Hanington et al., 2012; McMahon et al., 2006).

When maternal depression persists, the parent–child relationship worsens. Depressed parents view their infants more negatively than independent observers do (Forman et al., 2007). And they use inconsistent discipline—sometimes lax, at other times too forceful. As we will see in later chapters, children who experience these maladaptive parenting practices often have serious adjustment problems. Some withdraw into a depressive mood themselves; others become impulsive and aggressive. In one study, children born to mothers who were depressed during pregnancy were four times as likely as children of nondepressed mothers to have engaged in violent antisocial behavior by age 16, after other stressors in the mother’s life that could contribute to youth antisocial conduct had been controlled (Hay et al., 2010).


This father appears completely disengaged from his wife and toddler. If this continues, disruptions in the parent–child relationship will likely lead to serious child behavior problems.
© CATCHLIGHT VISUAL SERVICES/ALAMY
Paternal Depression
Paternal depression is also linked to dissatisfaction with marriage and family life after childbirth and to other life stressors, including job loss and divorce (Bielawska-Batorowicz&Kossakowska-Petrycka, 2006). In a study of a large representative sample of British parents and babies, researchers assessed depressive symptoms of fathers shortly after birth and again the following year. Then they tracked the children’s development into the preschool years. Persistent paternal depression was, like maternal depression, a strong predictor of child behavior problems—especially overactivity, defiance, and aggression in boys (Ramchandani et al., 2008).

Paternal depression is linked to frequent father–child conflict as children grow older (Kane & Garber, 2004). Over time, children subjected to parental negativity develop a pessimistic worldview—one in which they lack self-confidence and perceive their parents and other people as threatening. Children who constantly feel in danger are especially likely to become overly aroused in stressful situations, easily losing control in the face of cognitive and social challenges (Sturge-Apple et al., 2008). Although children of depressed parents may inherit a tendency toward emotional and behavior problems, quality of parenting is a major factor in their adjustment.

Interventions
Early treatment is vital to prevent parental depression from interfering with the parent–child relationship. Julia’s doctor referred her to a therapist, who helped Julia and Kyle with their marital problems. At times, antidepressant medication is prescribed.

In addition to alleviating parental depression, therapy that encourages depressed mothers to revise their negative views of their babies and to engage in emotionally positive, responsive caregiving is essential for reducing young children’s attachment and other developmental problems (Forman et al., 2007). When a depressed parent does not respond easily to treatment, a warm relationship with the other parent or another caregiver can safeguard children’s development (Mezulis, Hyde, & Clark, 2004).

Applying What We Know How Couples Can Ease the Transition to Parenthood
STRATEGY DESCRIPTION
Devise a plan for sharing household tasks. As soon as possible, discuss division of household responsibilities. Decide who does a particular chore based on who has the needed skill and time, not gender. Schedule regular times to reevaluate your plan to fit changing family circumstances.
Begin sharing child care right after the baby’s arrival. For fathers, strive to spend equal time with the baby early. For mothers, refrain from imposing your standards on your partner. Instead, share the role of “child-rearing expert” by discussing parenting values and concerns often. Attend a new-parenthood course together.
Talk over conflicts about decision making and responsibilities. Face conflict through communication. Clarify your feelings and needs, and express them to your partner. Listen and try to understand your partner’s point of view. Then be willing to negotiate and compromise.
Establish a balance between work and parenting. Critically evaluate the time you devote to work in view of new parenthood. If it is too much, try to cut back.
Press for workplace and public policies that assist parents in rearing children. Difficulties faced by new parents may be partly due to lack of workplace and societal supports. Encourage your employer to provide benefits that help combine work and family roles, such as paid employment leave, flexible work hours, and on-site high-quality, affordable child care. Communicate with lawmakers and other citizens about improving policies for children and families, including paid, job-protected leave to support the transition to parenthood.
A second birth typically requires that fathers take an even more active role in parenting—by caring for the firstborn while the mother is recuperating and by sharing in the high demands of tending to both a baby and a young child. Consequently, well-functioning families with a newborn second child typically pull back from the traditional division of responsibilities that occurred after the first birth. In a study that tracked parents from the end of pregnancy through the first year after their second child’s birth, fathers’ willingness to place greater emphasis on the parenting role was strongly linked to mothers’ adjustment after the arrival of a second baby (Stewart, 1990). And both parents must help their firstborn child adjust. Preschool-age siblings understandably may feel displaced and react with jealousy and anger—a topic we will take up in Chapter 7. For strategies couples can use to ease the transition to parenthood, refer to Applying What We Know above.

Single-Mother Families

About 40 percent of U.S. births are to single mothers, one-third of whom are teenagers (Martin et al., 2013). Because most adolescent parents suffer from personal, family, and financial problems, their newborns are at high risk for developmental problems.

Look and Listen

Ask a couple or a single mother to describe the challenges of new parenthood, along with factors that aided or impeded this transition.

At the other extreme, planned births and adoptions by single 30- to 45-year-old women are increasing. These mothers are generally financially secure, have readily available social support from family members and friends, and adapt to parenthood with relative ease. In fact, older single mothers in well-paid occupations who plan carefully for a new baby may encounter fewer parenting difficulties than married couples, largely because their family structure is simpler: They do not have to coordinate parenting roles with a partner, and they have no unfulfilled expectations for shared caregiving (Tyano et al., 2010). And because of their psychological maturity, these mothers are likely to cope effectively with parenting challenges.

The majority of nonmarital births are unplanned and to women in their twenties. Most of these mothers have incomes below the poverty level and experience a stressful transition to parenthood. Although many live with the baby’s father or another partner, cohabiting relationships in the United States are less socially acceptable than those in Western Europe, 

Answer

Psychology Questions

Question 1:

High levels of stress hormones can positively impact childbirth and at the same time can have adverse effects during fetal development. As the pregnancy advances, the placenta is stimulated to release high amounts of corticotrophin hormone. This hormone promotes the development of lungs in the fetus in preparation for breathing upon childbirth.

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However, the high level of maternal stress experienced by women during pregnancy place the fetus at risk. For instance, the fetus is susceptible to being underweight, contracting respiratory disorders, being highly irritable and in some cases, being born premature.

Question 2:

I would not consider this option at all. This is primarily because home delivery is based on the assumption that no difficulties will occur during childbirth. Again, the success of home birth is contingent on the competence of the attendant. Berk and Meyers (2016) assert that the probability of infant disability and mortality is high if the attendant is not qualified.

Question 3:

Sensitive care plays a pivotal role in the recovery of preterm infants.  In addition to this, the development of preterm infants relies heavily on the parent-child relationship. However, most parents become insensitive and less caring towards their preterm babies upon observing their appearance and behavior. Preterm babies, more so those perceived to have some disorders at birth are victims of such insensitive treatment since they do not interact as much with their parents.
Question 4:

I strongly concur with this assertion. Conclusive research indicates that premature babies are at higher risk of contracting serious developmental problems such as asthma, cerebral palsy and vision and hearing disorders as compare to normal-weight children.
Question 5:

Babies are born with a set of reflexes and capabilities that are paramount for survival and getting adult attention and care. For instance, rooting reflexes allow the infant to find the nipple whereas sucking the finger rhythmically permits feeding.

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Question 6

Postpartum depression impacts negatively on the parent-child relationship. Depressed parents tend to view their children negatively and this drives them to induce inconsistent and sometimes unwarranted discipline.
Question 7:

Employment leave provides the parent with ample time to connect with the child. The parent is able to spend more time with the infant and learn how to handle new responsibilities at the same time.
Question 8:

This is primarily because as a father, Derek is required to take up an even more active role in parenting. He is required to tend to the demands of the newborn and the first born while the mother is recuperating.

References

Berk, L. E., & Meyers, A. B. (2015). Infants, children, and adolescents. Pearson.

Sturge-Apple, M. L., Davies, P. T., Winter, M. A., Cummings, E. M., & Schermerhorn, A. (2008). Interparental conflict and children’s school adjustment: The explanatory role of children’s internal representations of interparental and parent-child relationships. Developmental Psychology44(6), 1678.

Thelen, E., Fisher, D. M., & Ridley-Johnson, R. (1984). The relationship between physical growth and a newborn reflex. Infant Behavior and Development7(4), 479-493.

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