Children 13th Edition Santrock Solutions Manual 1

Chapter 4 Birth
Solution Manual for Children 13th Edition by Santrock

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CHAPTER 4: BIRTH
Total Teaching Package Outline
Resources
WHAT HAPPENS DURING THE BIRTH PROCESS? LG #1
Stages of the Birth Process—First stage: Longest stage; lasts an LM #1
average of 12 to 24 hours; uterine contractions are 15 to 20 minutes ESS #2
apart and increase in frequency and intensity as stage progresses. WS #1, 4
Contractions last for about a minute.
Second stage: Begins when baby’s head moves through cervix and
birth canal and ends when baby completely emerges; typically lasts
about 45 minutes to an hour with contractions occurring every minute.
Third stage (afterbirth): Expelling of placenta, umbilical cord, and
other membranes.
 Childbirth Setting and Attendants—In the United States, CA #1, 6, 8
99% of births take place in hospitals, and more than 90% are RP #1, 2
attended by physicians. Compared to physicians, certified WS #3
midwives generally spend more time with women during HO #1
prenatal visits, place more emphasis on counseling and
education, provide more emotional support, and are more likely
to be with the woman one-on-one during the entire labor and
delivery process. In many countries, a doula attends a
childbearing woman. In many cultures, several people attend
the mother during labor and delivery. CA #4
 Methods of Childbirth—U.S. hospitals often allow the mother ESS #1, 3
and her obstetrician a range of options regarding method of WS #5, 6
delivery. HO #2
 Medication—Three basic drugs are used for labor:
analgesics are used to relieve pain; anesthesia blocks
sensation during labor; oxytocin is a synthetic hormone
that stimulates contractions. Different fetuses react
differently to medication, and high dosage may have
negative effects.
 Natural and prepared childbirth—Natural childbirth
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Chapter 4 Birth
reduces pain by increased education on birthing without

medication and breathing and relaxation techniques.,
while prepared childbirth (Lamaze) includes a special
breathing technique to control pushing in the final stages
of labor. WS#2
 Cesarean delivery—Surgical procedure where incision is
made in the mother’s abdomen. Necessitated by baby’s
position, mother’s condition, and/or physical capability.
 The Transition from Fetus to Newborn—Being born CA #7
involves considerable stress for the baby. The supply of oxygen ESS #5
to the fetus is decreases as uterine muscles draw together, and HO #4
large quantities of adrenaline and hormones are secreted to
protect the newborn. LG #2
ESS #10
WHAT ARE SOME MEASURES OF NEONATAL HEALTH
AND RESPONSIVENESS?
 Apgar Scale—The Apgar Scale is widely used to determine an
infant’s immediate health status and evaluates infants’ heart
rate, respiratory effort, muscle tone, body color, and reflex
irritatibility.
 Brazelton Neonatal Behavioral Assessment Scale (NBAS)—
The NBAS assesses the newborn’s neurological development,
reflexes, and reactions to people and is performed within 24 to
36 hours after birth. It is also used as a sensitive index of
neurological competence up to a month after birth.
 Neonatal Intensive Care Unit Network Neurobehavioral
Scale (NNNS)—The NNNS provides a more comprehensive LG #3
analysis of the newborn’s behavior, neurological and stress LM #2
responses, and regulatory capacities for at-risk infants. ESS #4, 6, 7
HOW DO LOW BIRTH WEIGHT AND PRETERM INFANTS
DEVELOP?
 Preterm and Small for Date Infants—Low birth weight
infants weigh less than 5.5 pounds at birth. Preterm infants
are born three weeks or more before the pregnancy has reached
its full term. Small for date infants are those whose birth
weight is below normal when the length of the pregnancy is
considered.
 Consequences of Preterm Birth and Low Birth Weight—
Although most preterm and low birth weight infants are normal
and healthy, as a group they have more health and
developmental problems than normal birth weight infants, and CA #3
the number and severity of these problems increase with very ESS #8
early birth and as birth weight decreases. Potential problems
include brain injuries, lung and liver diseases, learning
Chapter 4 Birth
disabilities, and breathing problems.

 Nurturing Preterm Infants—Intensive enrichment programs
that provide medical and educational services for both the
parents and children can improve short-term outcomes for low
birth weight children. Two increasingly used interventions LG #4
currently are massage therapy and kangaroo care, a way of LM #3
holding a preterm infant so that there is skin-to-skin contact. CA #5
WHAT HAPPENS DURING THE POSTPARTUM PERIOD?

Postpartum period—The 6-week period following birth in which the
mother adjusts physically and psychologically to the process of
childbearing. PA #1
 Physical Adjustments—A loss of sleep during and after ESS #11, 12
pregnancy, as much as 700 hours, can contribute to stress, HO #3
relationship conflict, and impaired decision making.
Involution is the process by which the uterus returns to its
prepregnancy size in the five to six weeks after birth. Exercise,
during and after pregnancy, can help mothers recover former
body contour and strength. It also contributes to maternal well CA #2
being as do relaxation techniques.
 Emotional and Psychological Adjustments—Emotional
fluctuations are common for mothers in the postpartum period
and may decrease within weeks after pregnancy or may be long
term. Postpartum depression involves a major depressive ESS #13
episode that typically occurs about four weeks after delivery. PA #2
Several antidepressant drugs are effective in treating
postpartum depression, as is psychotherapy and, to a smaller
extent, exercise. Fathers also undergo considerable adjustment
and experience considerable stress.
 Bonding—The formation of a connection, especially a physical
bond, between parents and the newborn in the period shortly
after birth. Research is conflicted on the importance of bonding
in the first several days after birth.
Resource Key
LG – Learning Goal ESS – Essay
LM – Lecture Material WS – Web Site Suggestions
CA – Classroom Activity RP – Research Project
HO – Handout PA – Personal Application
Chapter 4 Birth
Learning Goals
4.1 Discuss the stages, decisions involved, and transitions in birth.

Stages of the Birth Process
Childbirth Setting and Attendants
Methods of Childbirth
The Transition from Fetus to Newborn
4.2 Describe three measures of neonatal health and responsiveness.
4.3 Characterize the development of low birth weight and preterm infants.
Preterm and Small for Date Infants
Consequences of Preterm Birth and Low Birth Weight
Nurturing Preterm Infants
4.4 Explain the physical and psychological aspects of the postpartum period.
Physical Adjustments
Emotional and Psychological Adjustments
Bonding
Key Terms
afterbirth Neonatal Intensive Care Unit Network
doula Neurobehavioral Scale (NNNS)
analgesics low birth weight infants
anesthesia preterm infants
oxytocin small for date (small for gestational age)
natural childbirth infants
prepared childbirth kangaroo care
breech position postpartum period
cesarean delivery involution
Apgar Scale postpartum depression
Brazelton Neonatal Behavioral Assessment bonding
Scale (NBAS)
Biography Highlights
Grantly Dick-Read (1890–1959) was a British gynecologist who studied at Cambridge and at the
London Hospital. His unorthodox work, Natural Childbirth (1933), with its rejection of anesthetics
during childbirth and its advocacy of prenatal relaxation exercises, caused controversy but later found
common acceptance. In 1948, he immigrated to South Africa, where in 1954 he conducted a tour of
African tribes investigating childbirth.
Ferdinand Lamaze (1891-1957) was a French gynecologist who developed a method of birthing in
which the mother learns to control the pain by conquering her fear through knowledge and support. He
Chapter 4 Birth
believed a woman also must alter the perception that she was suffering, and would remain awake through
labor, aware and in control of her own body. This revolution in perception would come about through
newly learned conditioned reflexes that, instead of signaling pain, would signal the work of producing a
child. Lamaze adapted his methods from those observed and developed in Russia by Velvovsky and
others from Pavlovian psychophysiology. The basis of the techniques came from the experiments of
Pavlov and his salivating dog.
T. Berry Brazelton is clinical professor emeritus of Pediatrics at Harvard Medical School and professor
of Psychiatry and Human Development at Brown University. He earned his M.D. in 1943 from Columbia
University, and in 1951, he became an instructor at Harvard Medical School, where he began conducting
research to help parents better understand their children. In 1972, with Edward Tronick, he cofounded
the Child Development Unit at the Children’s Hospital in Boston, Massachusetts. The following year,
Brazelton and his colleagues developed the Brazelton Neonatal Behavioral Assessment Scale, an
evaluation tool used to assess physical and neurological responses in infants. That scale continues to be
used in research and clinical settings around the world, and Brazelton has said that he considers it to be
his greatest contribution to the field of pediatrics. As one of America’s best-known pediatricians, Dr.
Brazelton’s books are likely to be found on the shelves of anxious parents beside the classic Baby and
Child Care by Dr. Spock.
Barry Lester is director of the Infant Development Center at Women & Infants Hospital in Providence,
Rhode Island, which houses the Colic Clinic. He is also professor of psychiatry and human behavior and
professor of pediatrics at Brown Medical School.
Edward Tronick is Associate Professor of Pediatrics of Harvard Medical School and Associate Professor
in the Department of Society, Human Development, and Health of the Harvard School of Public Health.
He earned his Ph.D. in 1968 at the University of Wisconsin. Current projects of his research team include
examining the effects of in utero cocaine exposure and periventricular lesions on infants' neuromotor
motor functioning and examining the effects of in utero exposure on the social interactions of in utero
exposed 6-month-old infants and their mothers.
Tiffany M. Field is a director of the Touch Research Institute at the University of Miami School of
Medicine and Nova Southeastern University (NSU) and the Dean of the Family and School Center at
NSU. She is recipient of the American Psychological Association Distinguished Young Scientist Award
and earned a Research Scientist Award from the National Institute of Mental Health (NIMH) for her
research center. She is the author of Infancy, Touch, Advances in Touch, and more than 350 journal
articles, and is the editor of a series of volumes on High-Risk Infants and Stress & Coping.
Highlights of Research
(These highlights are given here in the order that they appear in the chapter.)
1. Stein, M. T., Kennell, J. H., and Fulcher, A. (2004). Benefits of a doula present at the birth of
a child. A discussion of a case in which a doula was present at childbirth and beyond is
presented. This challenging case is an opportunity to explore the activities of a doula and to
review recent studies that evaluate the effect of a doula on perinatal and developmental
outcomes.
2. Balchin, I., & Steer, P. J. (2007). Race, prematurity, and immaturity. Compared to white
Europeans, Blacks and South Asians have a significantly shorter mean gestational length and
Chapter 4 Birth
a higher incidence of preterm birth.

3. Moster, D., Lie, R. T., & Markestad, T. (2008). Long-term medical and social consequences
of preterm birth. In a cohort of people in Norway who were born between 1967 and 1983, the
risks of medical and social disabilities in adulthood increased with decreasing gestational age
at birth.
4. Field, T., Hernandez-Reif, M., & Diego, M. (2006). Newborns of depressed mothers who
received moderate versus light pressure massage during pregnancy. Neonates whose
mothers received moderate pressure massage spent a greater percent of the observation time
smiling and vocalizing, and they received better scores on the orientation, motor, excitability,
and depression clusters of the Brazelton scale.
5. Runquist, J. J. (2007). A depressive symptoms responsiveness model for differentiating
fatigue from depression in the postpartum period. The Depressive Symptoms
Responsiveness Model proposes that depression- related postpartum fatigue may potentially
be differentiated from non-depression-related postpartum fatigue on the basis of whether
depressive symptoms abate when fatigue is relieved.
6. Blum, J. W., Beaudoin, C. M., & Caton-Lemos, L. (2004). Physical activity patterns and
maternal well-being in postpartum women. Postpartum sports/exercise activity, education,
and socioeconomic status were predictors of maternal well-being. In general, better maternal
well-being was found among subjects maintaining or increasing sports/exercise activity
compared to those with no or decreased sports/exercise activity prepregnancy to postpartum.
Support from partner/husband, family, and friends were significant factors in maintaining or
increasing sports/exercise activity.
7. Teti, D. M., Killeen, L. A., Candelaria, M., Miller, W., Hess, C. R., & O’Connell, M., (2008).
Adult attachment, parental commitment to early intervention, and developmental outcomes in
an African American sample. Autonomous states of mind were predictive of maternal
sensitivity and security of infant-mother attachment, particularly among mothers of 24-
month-old infants, but not earlier. Socioeconomic background was a significant predictor of
mothers' quality of engagement in the intervention.
8. Feldman, R., & Eidelman, A. I. (2009). Biological and environmental initial conditions
shape the trajectories of cognitive and social-emotional development across the first years of
life. Neonatal vagal tone improved cognitive and social-emotional growth-rates across the
first year, whereas maternal depressive symptoms interfered with growth from 2 to 5 years.
9. Bakeman, R., & Brown, J. (1980). Early interaction: Consequences for social and mental
development at three years; and Rode, S., Chang, P., Fisch, R., & Sroufe, A. (1981).
Attachment patterns of infants separated at birth. These studies challenge the significance of
the first few days of life as a critical period.
10. Lamb, M. (1994). Infant care practices and the application of knowledge. The infant will not
be harmed emotionally if parents do not have the baby stay with the mother during her time
in the hospital in an effort to promote bonding.
Chapter 4 Birth
Lecture Material
1. Approaches to Childbirth
Throughout history, women have had to bear the pain of childbirth, often at the hands of well-
meaning but uninformed doctors. A common procedure was to apply live birds to the patient’s
feet and then, paradoxically, to let blood to stop hemorrhaging. The mortality rate among
mothers in England in the first half of the seventeenth century is estimated to be at 158 per 1,000.
The life expectancy for women was 45 years, mainly because of the dangers of having a child
(Fraser, 1984). The mortality rate for mothers in 1996, on the other hand, was 8.6 per 100,000
live births. Infant mortality rates were 7.3 per 1,000 live births, down from 29.2 in 1950.
It is estimated that less than 2% of all births in America between 1700 and 1750 were
physician assisted, compared to 98% in 1950 to 91% in 1996, while in 1700, more than 90% of
births were midwife attended, which dropped to 2% in 1950 and went to 6.14% in 1996 and is
currently rising. American women are changing the experience of birthing because of men like
Lamaze, Bradley, and LeBoyer, who have pioneered methods of giving birth that place the event
back into the control of the woman and her husband/mate. Additionally, the growth in the
number of licensed nurse-midwives has resulted in birth room scenarios that look surprisingly
similar to those of the 1700s.
In two studies completed by the Centers for Disease Control (2000) and the National Center
for Health Statistics (1998), infant mortality risks were examined in 1991 of all vaginal births in
the United States delivered by physicians or certified nurse-midwives. After controlling for
social and medical risk factors, the infant death rate was 19% lower for births attended by the
midwives than for those attended by physicians (MacDorman & Singh, 1998). Neonatal deaths
(first 28 days of birth) were 33% lower, and the risk of low birth weight deliveries was 31%
lower. The authors of the study thought that the midwives spent more time in prenatal care and
developed a stronger bond with their patients.
It is estimated that of the 4 million births in 1992, 2.6 million involved women who had
prepared themselves for labor with some kind of childbirth education. Among the 2.2 million
first-time mothers, approximately 75% took some kind of childbirth-education class. Santrock
gives an excellent summary of the main programs in use in the United States; however, some
recent studies have found that the usefulness of such programs may be overemphasized. One
study found that the programmed group encountered more stress than the control group. In
another study, 61% reported difficulty when trying to implement the Lamaze method.
Writing in the New York Times, Randi Hutter Epstein (2001) recalls her experience of giving
birth to one of her four children in England. She noted that the medical proficiency was no better
or worse than that received when she gave birth to three of her children in the United States, but
that the attitudes toward pregnancy and especially the postpartum experience stood in stark
contrast. Drinking a glass of wine per day during her pregnancy was viewed without alarm or
condemnation. Once her child was born, a midwife visited her every day for 10 days after the
birth. This is a standard requirement for all babies born in England, rich or poor. The midwife’s
responsibility is to monitor the progress of the mother’s recovery as well as the health of the
child. Mrs. Epstein found these visits to be friendly, supportive, and welcoming, and they had the
effect of assuring her through a period when mothers need to recover from the physical and
emotional trauma of giving birth.
References
Chapter 4 Birth
Centers for Disease Control and Prevention. (2000). Vital statistics of the United States. National Center
for Health Statistics. Retrieved November 22, 2001, from http://www.cdc.gov/nchs/products/vsus.htm
Epstein, R.H. (2001, December 4). So lucky to give birth in England. New York Times, 6.
Fraser, A. (1984). The weaker vessel. New York: Alfred Knopf.
MacDorman, G., & Singh, S. K. (1998). Midwifery care, social and medical risk factors and birth
outcomes in the USA. Washington: National Institute for Health, Centers for Disease Control.
National Center for Health Statistics. (1998). National Ambulatory Medical Survey. Retrieved November
13, 2001, from http://www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm.
2. The Benefits of Co-Bedding

The practice of co-bedding preterm infant twins and other multiples involves lightly swaddling
them together in the same blanket in a position that mimics their position in utero, either face to
face or spooning one another. Though fairly common in other countries, especially those in
Europe, co-bedding has been infrequently practiced in the United States, where physician
concerns for infection precluded use of the technique (Twin Peas in a Pod, 2004).
The benefits of co-bedding, however, have been the subject of considerable research interest
since the highly publicized case of twins Kyrie and Brielle Jackson, whose story and photograph
became known as “The Rescuing Hug.” Born 12 weeks early on 17 October 1995 at the
University of Massachusetts Memorial Hospital in Worcester, MA, the twins each weighed
around 2 pounds at birth. While Kyrie gained weight and appeared to make progress in the days
that followed, Brielle struggled with a battery of problems including breathing issues, troubling
blood oxygen levels, and heart rate difficulties. On a difficult day when the twins were a little
less than a month old, Brielle became increasingly stressed and her condition worsened despite
the exhaustive efforts of the baby’s parents and 19-year-old Newborn Intensive Care Unit nurse
Gayle Kasparian. Recalling what she had heard about the practice of co-bedding in Europe,
Kasparian obtained permission from the babies’ mother to place them together in the same
incubator. The effects were so abrupt that Kasparian thought her equipment was malfunctioning.
Brielle immediately stopped crying, snuggled up to Kyrie, and regulating her breathing to
Kyrie’s pace, her blood oxygen levels and heart rate dramatically improved. Brielle continued to
make progress over the next few weeks as she remained physically in contact with Kyrie
(O’Brien, n.d.). When Brielle and Kyrie went home with their family at age 2 months, they each
weighed well over 5 pounds and were considered healthy.
Since the success of the technique with the Jackson twins, U.S. hospitals have co-bedded
hundreds of sets of twins, triplets, and quadruplets. While co-bedding is not recommended in all
cases (such as when one or more infants has an infection or requires mechanical ventilation), the
results of co-bedding have been overwhelmingly positive (Developmental Care/Co-bedding,
2005). Research indicates that co-bedded infants tend to have better feeding patterns, respiratory
control, and heart rates, and because a sibling’s movement can help stimulate the other if one is
having breathing problems, co-bedded babies require less time on oxygen (Twin Peas in a Pod,
2004). The technique is also psychologically comforting to parents, allows nurses to care for the
children and communicate with their families more consistently, and has been associated with an
improved transition to home and decreased hospital readmissions (Freeman & Hwang, 2004).
References
Developmental Care/Co-bedding (2005). Retrieved June 28, 2005, from

Chapter 4 Birth
http://neonatalnetwork.metapress.com/content/mq35327k23g86476/.
Freeman, H., & Hwang, P. (2004) Co-bedding multiple gestation neonates in the NICU
(Protocol). El Camino Hospital, Mountain View, CA.
O’Brien, M. (2004). The rescuing hug: The benefits of co-twinning.
Twin Peas in a Pod (2004, February 11). Retrieved June 28, 2005, from
http://www.ellisfischel.org/~children/twinning.shtml.
3. Postpartum Depression
In light of the media coverage of the Andrea Yates case in recent years, your students may be
interested in a discussion of the definition and prevalence of psychological disorders associated
with the postpartum period. On June 20, 2001, Andrea Yates admitted to drowning in the bathtub
her five children, ages 6 months to 7 years, before calling the police and her husband to their
home. Yates had a previous history of postpartum depression and psychosis, including a suicide
attempt in June 1999 that occurred after the birth of her fourth child. Although Andrea’s husband
Russell claimed that Andrea appeared to make a full recovery, she experienced another bout of
postpartum depression after the birth of their fifth child in November 2000. This prompted them
both to make the decision to hold off on having any more children.
There are three types of PPD women can have after giving birth (National Women’s Health
Information Center, 2001). As Santrock notes, the symptoms of the baby blues usually occur 2 to
3 days after the birth of a baby and subside within a few weeks. A new mother experiencing the
baby blues can have sudden mood swings, cry for no apparent reason, and feel impatient,
irritable, restless, anxious, lonely, and sad. The baby blues do not usually require treatment from
a health-care provider. Often, joining a support group of new moms or talking with other moms
helps.
Beginning within 4 weeks of the birth of a baby, postpartum depression (PPD) is a subtype
of major depression. The symptoms of PPD, which affects about 10% of new mothers, are
similar to the baby blues—sadness, despair, anxiety, irritability—but are experienced more
intensely than with the baby blues (National Women’s Health Information Center, 2001). When
PPD interferes with a mother’s ability to function, this is a sign that she needs to see her health-
care provider right away. Left untreated, PPD symptoms can worsen and last for as long as a
year. As noted in the text, several treatments are available for PPD, including cognitive therapy
(e.g., Beck, 2002), estrogen therapy (e.g., Grigoriadis & Kennedy, 2002), and antidepressants
(Sharma, 2002).
Postpartum psychosis is a very serious mental illness that can appear within the first 3
months after childbirth. Relatively rare, postpartum psychosis affects about 1 in 500–1,000
mothers (National Women’s Health Information Center, 2001). Women afflicted with
postpartum psychosis can experience auditory hallucinations (hearing things that aren't actually
happening, like a person talking) and delusions (holding untrue beliefs about reality that persist
in spite of counterevidence). Other symptoms associated with postpartum psychosis include
insomnia, feeling unsettled and angry, and a sense of being disconnected from reality.
Individuals experiencing the symptoms of postpartum psychosis are at risk for hurting
themselves or someone else and so require immediate treatment and almost always need
medication.
Andrea Yates was diagnosed with postpartum psychosis after the birth of her fourth child,
although she had experienced delusional episodes ever since her first child was born. Family
members and friends somehow missed or ignored warning signals, which included severely
Chapter 4 Birth
depressed states of mind, delusions, unresponsive behaviors toward her children, hallucinations,
and a suicide attempt. Yates pleaded not guilty by reason of insanity to two counts of capital
murder in the deaths of three of the children. Jurors in her case deliberated for 3 hours and 40
minutes before finding Yates guilty of murder on March 13, 2002. The jury spared her life, with
a sentence of life in prison instead of the death penalty (CNN, 2003).
The complexity of the Andrea Yates case has not been lost on the many psychologists,
feminists, and legal analysts who understand the important implications of the verdict. Toward
the end of her trial in March 2002, the image of a woman not just "depressed," but seriously
delusional, began to emerge in bits and pieces from the courtroom. Following her suicide
attempts, doctors put Andrea Yates on the antipsychotic drug Haldol, and the couple was told
that as long as she took her medication and had no more children, she would be all right
(Kennedy, 2002).
Soon after the verdict was reached, controversy began to stir about the culpability of her
husband, Russell Yates, in the tragic event. The Yateses had apparently been very influenced by
preacher Michael Woroniecki and his wife, who lived in a bus, home-schooled their children,
and believed that “all women are witches,” while men are “wimps.” Until Andrea attempted
suicide after the birth of their fourth son in 1999, the Yateses had also lived in a converted bus.
Russell, who had been quoted as saying that he and Andrea wanted to live "a simple traditional
life" and that they wanted to avoid "social integration,” then moved the family into a house, and
they decided that Andrea should home-school their children. The preacher believed that society
damages children, and that by the time a child is 14 or 15, it is too late to undo the damage.
Russell referred to these beliefs in his courtroom explanation of his wife’s killing of their young
children: "It might keep them from following the Lord long-term" (Kennedy, 2002).
See Classroom Activity #5 for a suggestion for further exploration of these issues.
References
Beck, C. T. (2002). Theoretical perspectives of postpartum depression and their treatment implications.
American Journal of Maternal/Child Nursing, 27, 282–287.
Cable News Network (2002). Andrea Yates case: Texas mother gets life in prison. Retrieved May 11,
2009, from http://www.cnn.com/2007/US/law/12/11/court.archive.yates1/index.html
Grigoriadis, S., & Kennedy, S. H. (2002). Role of estrogen in the treatment of depression. American
Journal of Therapy, 9, 503–509.
Kennedy, J. (2002). What weren’t we discussing about Andrea Yates? Free Inquiry Magazine, 22(3),
National Women’s Health Information Center (2001). Postpartum depression fact sheet. Retrieved
December 28, 2003, from http://www.4woman.gov/faq/postpartum.htm
Sharma, V. (2002). Pharmacotherapy of postpartum depression. Expert Opinions on Pharmacotherapy, 3,
1421–1431.
Chapter 4 Birth
Classroom Activities
1. See Handout #1 on childbirth education programs. Have each student complete an evaluation
of the programs. Students will be required to access this information either from the text or from
Web sites (see Web Site Suggestions). After dividing the class into some arrangement of your
choice, have each group present a summary of the program providing the optimum benefits to
the birthing couple.
2. As with new mothers, new fathers also require a period of adjustment after their child is born.
According to Johnson (2002), a common reaction among fathers is a feeling of replacement by
the baby—instead of him, the baby now comes first and gets all of the attention from his partner.
Have students work in small groups to discuss the steps that expectant mothers and fathers may
make to help new fathers cope with the life transitions of the arrival of a child. Invite students to
share their ideas with the class.
Reference
Johnson, M. P. (2002). The implications of unfulfilled expectations and perceived pressure to attend the
birth on men’s stress levels following birth attendance: A longitudinal study. Journal of Psychosomatic
Obstetrics and Gynecology, 23, 173–182.
3. The roles of mothers and fathers in having and rearing children have undergone considerable
change in the United States over the past century with the influx of the immigration of members
of diverse cultural groups. Have your students discuss the history and status of cultural practices,
traditions, and beliefs surrounding pregnancy and childbirth. Cultural issues to consider may
include:
 Religious beliefs and observances
 Food and dress
 Behavioral commonalities
 Music and lifestyle
 Gender roles and parenting
4. Childbirth practices in the United States are in many ways very different from those of other
countries. Handout #2 presents a list of birthing practices in various cultures throughout the
world. Have your class discuss the probable reasons or origins for each of the practices
described. Do Americans have similar superstitions regarding birth? Conclude this activity with
a written assignment, which might involve students’ personal narratives on childbirth from their
perspective; or have them research some of the birthing practices mentioned and give an oral or
written report on their origins.
5. Following your presentation of the material in Lecture Material #3, engage your students in
a debate about the responsibility of Andrea Yates and Russell Yates in the deaths of their
children. To stimulate discussion, distribute Handout #3, which includes the following questions
for students to consider:
 If Andrea Yates was psychotic at the time of the killings, should the jury have agreed
with the defense’s plea of not guilty by reason of insanity?
Chapter 4 Birth
 Should Russell Yates have continued having children with Andrea after her previous
postpartum depression, psychosis, and suicide attempts following the birth of her fourth
child? If not, do you believe he is also at fault for the tragedy?
 How might the family’s social isolation have contributed to the tragedy?
 What kinds of community support could the family have enlisted to assist Yates?
6. Many Americans like to record important events in their lives. Poll the class on opinions about
a father taping the birth of his child. Ask them to consider the potential reactions of the father,
mother, and children to watching a video of the birth.
7. Birth exposes babies to a host of physical, behavioral, and social changes to which they must
adjust. With respect to the social world, babies experience strong reactions to and expectations
related to their gender. Have students examine greeting card birth announcements for boys and
girls and use Handout #4 to record their observations. How is gender constructed and
communicated from the moment a child is born (and before)? What sorts of adjectives and
images are used in cards for boys and girls? As future parents, what are students’ attitudes about
the use of stereotypes in these greeting cards? This activity can be done either as a homework
assignment or you can supply students with cards in class.
8. To give students a more in-depth look at the chapter material, invite a childbirth educator to
class for a day. Have students come prepared with questions about the birth process, childbirth
strategies and decisions, measures of neonatal health and responsiveness, and adjustments on the
part of parents, siblings, and newborns. Students will appreciate a chance to hear about the
experiences of and have their questions answered by an expert on the process.
9. See Handout #5 for students’ personal reflections on two topics covered in this chapter.
Students may choose topics on choices for the birth process and the postpartum experience.
Stress to the class that personal reflections are necessary, but may be hypothetical if they are
uncomfortable writing about themselves. The reflection should be no less than 1-1/2 pages
double-spaced.
Chapter 4 Birth
Critique a Child Development Article

Choose one article from any periodical or journal on one of the following topics:
 The birthing process

 Techniques and/or problems with abortion
 The effects of society and the individual
 Adjusting to parenthood
Using the questions listed as follows, write a critique of the article from the viewpoint of a
scientist seeking the truth. This paper should be 3 to 6 pages long, double-spaced.
 What is the topic of the article? What are some examples of information provided?
 Does the article emphasize heredity (nature) or environment (nurture)?
 To which domain of child development does it refer (physical, socioemotional,
cognitive)?
 Does the article rely on scientific findings, expert opinion, or case example?
 Do the conclusions of the article seem valid?
 In a concluding paragraph(s), give your personal evaluation of what was covered in the
article and whether it advances our knowledge and understanding of child development
Research Projects
1. Research newspapers and popular magazines for advertisements for expectant parents.
Assess the tone and target of these ads. Prepare a report about the depth of influence the media
and commercialism has on parenthood. Consider the following questions:
 To what extent does commercialism affect our cultural concept of having children?
 How extensive are the conceptual paradigms formulated through TV sitcoms or dramas?
 Is there any basis for this effect being more or less influential on single mothers, parents
of low socioeconomic status, or more educated and/or affluent parents?
2. Contact local agencies, hospitals, and medical groups for the names of midwives. Interview
three of these individuals about how they see their role in the birth process, how they would
compare or contrast their work to that of attending physicians, and what inspired them to choose
their line of work. In your report, relate your findings to text and lecture material concerning
midwife-attended childbirth.
Personal Applications
1. Spacing of Siblings
How many years should parents wait before having another child? Is there an “optimal” spacing
of siblings?
Chapter 4 Birth
 Instructions to Students: Calculate the number of years between you and your siblings (if you
have any). How do you think this spacing influenced your relationship with your siblings?
Do you feel closer to your siblings because you’re close in age, or does this closeness in age
breed jealousy and competition? Reflect on what would be the “optimal” spacing between
siblings. Your decision should involve issues discussed in previous chapters of the Santrock
text (e.g., the development of self, personality, gender roles, and so on).
 Use in the Classroom: Ask students to share their perspectives regarding the “optimal”
spacing of siblings. Discussion should explore reasons for students’ choices and should also
highlight the effect of other factors (e.g., parenting behavior, temperament of children) in the
quality of relationships between siblings.
2. Mothers and Fathers …The Same or Different?

This activity is intended to get students to reflect on their experiences with their mothers and
fathers. Did their mothers and fathers treat them differently (e.g., did mothers take on more of a
caretaker role, whereas fathers became the “play partner”?)? Do they believe that their mothers
and fathers influenced them in different ways?
 Instructions for Students: Think about your childhood experiences with both your mother and
your father. If you were asked to classify each parent’s parenting style (e.g., authoritarian,
authoritative, and so on), would your parents be classified the same? Did your parents engage
in different activities with you (e.g., mother took care of the house and helped with
homework, father was active in sporting activities)? Did you behave differently with each
parent? Could your behavior have affected your parents’ behavior towards you? How have
your mother and father influenced your development? Do you think that they influenced you
in similar ways (e.g., your values are a product of both parents) or different ways (e.g., you
are more concerned with meeting your father’s expectations than your mother’s…your
mother seems easier to please/more accepting…)?
 Use in the Classroom: Ask students to share their answers to the above questions. Class
discussion should focus on the effects of mothers and fathers on child development.
Discussion should also involve the bidirectional effects of parenting (i.e., parents influence
children, children influence parents).
Chapter 4 Birth
Essays
1. Compare and contrast the advantages and disadvantages of cesarean delivery to natural
childbirth. Consider possible explanations for the dramatic rise in the number of cesarean
deliveries in the United States in recent years.
2. Describe the three stages of labor as outlined in your text, and explain the possible
complications that might occur during each stage.
3. List the common drugs typically administered to women giving birth, and discuss their
relative risks to the mother and/or newborn.
4. Compare and contrast how the risks of neonatal mortality and low birth weight may differ for
babies delivered by certified midwives than for those delivered by physicians.
5. Summarize the changes involved for babies in the transition from fetus to newborn.
6. Distinguish between the terms preterm, small for date, and low birth weight. What are the
characteristics and concerns associated with each category?
7. Discuss possible reasons that the probability of a low birth weight or preterm baby may vary
with socioeconomic status of the mother.
8. Discuss the findings of research on the therapeutic effects of massage and kangaroo care for
preterm infants.
9. Suggest some activities in which parents may engage to help prepare older siblings for the
birth of a new child. Under what circumstances might parents wish to limit the involvement
of older children in the birth of a sibling?
10. The Apgar Scale and Brazelton’s birth scales are indicators of the infant’s overall condition
at the moment of birth. Compare and contrast these two instruments with attention to the
particular features of each and how and to what extent they determine the health of the child.
11. Describe the physical and psychological processes involved in the postpartum adjustment
period of mothers. What are some signs that could indicate a need for professional help in
treating postpartum depression?
12. Explain the adjustments that fathers are likely to face in the postpartum period. What are
some of the typical psychological concerns of new fathers?
13. Discuss the empirical support for the importance of early bonding between parents and their
newborn.
Chapter 4 Birth
Web Site Suggestions
2. http://www.maternitywise.org
Links to many other sites dealing with maternal and child care. Information on cesarean birth,
preterm labor, postpartum period, and postnatal care can be obtained.
3. http://www.midwiferytoday.com/
Articles, stories, news, and reviews relating to midwifery.
4. http://pregnancy.about.com/od/laborbirth/
Information on a multitude of topics associated with labor and birth, including delivery methods,
the role of fathers, potential complications, and postpartum issues.
5. http://www.nlm.nih.gov/medlineplus/cesareansection.html
Information on cesarean birth and deals with topics such as understanding C-sections, the risks
associated with C-sections, types of C-sections that are available, and the emotional issues of a
C-section.
6. http://www.babycenter.com/0_giving-birth-by-cesarean-section_160.bc
Information about cesarean births from babycenter.com.
7. http://www.circumcision.org
A circumcision resource center with links to recent medical studies, information on infant
response to circumcision, and circumcision counseling.
8. http://www.cirp.org/
Articles, studies, and information on the advantages and disadvantages of circumcision.
Chapter 4 Birth
Assets Available in Connect

A selection of resources assignable and assessable within Connect.
Asset Type Asset Title Page Learning Objective

Number
Video Midwifery 91 4.1 Describe the birth process.
Chapter 4 Birth
HANDOUT #1
CHILDBIRTH EDUCATION AND PLANNING PROGRAMS

Using your text, the Internet, library resources, or the local community action center on
pregnancy and child welfare, evaluate at least three childbirth education programs (e.g.,
Lamaze, Bradley, LeBoyer) following the framework given in the following chart. Consider the
following points in your evaluation:
 Main Features—What claims does the program make to help women?

 Time Involved—What requirements are given for the mother and/or the couple regarding
attendance of classes and practice at home?
 Expense—What is the total expense for the program, including travel, babysitters, etc.?
 Your evaluation—Based on the information you have read on these programs, give your
analysis of the effectiveness of each regarding benefits, practicality, and value for the
money and time spent.
Method Main Features Time Involved Expense Your

Evaluation
Chapter 4 Birth
HANDOUT #2
CROSS-CULTURAL PRACTICES OF CHILDBIRTH

The following are cross-cultural birth practices and beliefs that extend over the globe. You may
wish to share these with your class as you look at modern Western culture’s view of having a
baby.
 West Africa: Women are expected to give birth without making any sounds; girls who cry
out are called cowards and are expected to have longer labor.
 Latin American peasants: Massaging to direct the baby down and using long pieces of
cloth bound across the upper abdomen are used in the belief that babies might otherwise
travel upward instead of descending into the vagina.
 East Africa: Women experiencing long labor have their vaginas packed with cow dung to
encourage the baby to want to be born (i.e., the baby will believe it is being born into a
wealthy family).
 Cuna Indians of Panama: The shaman sings the baby out of the woman’s body.
 Zuñi Indians: Birth takes place on a hot sand bed 20 inches across and 5 inches high
covered by a sheepskin. The sand bed is symbolic of Mother Earth.
 The Zia of New Mexico: The father dips eagle feathers in ashes and throws the ashes in
the four directions. Then he draws the ashy feather down the pregnant woman’s sides and
center of the body while praying. The father’s sister places an ear of corn near the
pregnant woman’s head and blows on it during the next contraction to aid the father’s
prayer.
 India: A budded flower is placed near the pregnant woman, and her cervix is encouraged
to dilate as the flower’s petals open.
 Manus of New Guinea: The husband and wife are to confess any hidden angers toward
each other so that the childbirth process can proceed normally. A hot coconut soup is
used to comfort the mother.
 Jamaica: Childbirth is quickened if the mother smells the sweaty shirt of the father.
Chapter 4 Birth
HANDOUT #3
REFLECTING ON THE ANDREA YATES CASE

1. If Andrea Yates was psychotic at the time of the killings, should the jury have agreed with the
defense’s plea of not guilty by reason of insanity?
2. Should Russell Yates have continued having children with Andrea after her previous
postpartum depression, psychosis, and suicide attempts following the birth of her fourth child? If
not, do you believe he is also at fault for the tragedy?
3. How might the family’s social isolation have contributed to the tragedy?
4. What kinds of community support could the family have enlisted to assist Yates?
Chapter 4 Birth
HANDOUT #4
GENDER IN BIRTH ANNOUNCEMENTS
Gender Adjectives Images
Girl
_________________________________________________________________________
Boy
Chapter 4 Birth
HANDOUT #5
PERSONAL REFLECTIONS
on the themes presented in this chapter
Review the learning goals and the summaries following each as presented throughout the
chapter. From these, glean what you consider to be the two major themes of this chapter. (You
may choose more than two.)
1. ___________________________________________________________________________
___________________________________________________________________________
2. ___________________________________________________________________________
___________________________________________________________________________
On a separate sheet of paper, write your personal reflections of child development relative to
ONE of these themes. You will be writing about impressions of what has been discussed in class
and presenting your own views using personal experiences or those of people you have known.
(Note: Writing about your personal experiences is voluntary and not required for this assignment.
You may use hypothetical situations or write about the experiences of people you know or have
known.)
Be sure to conclude by writing a general statement regarding child development that would
summarize one of the themes of this chapter.

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Chapter 4 Birth

Solution Manual for Children 13th Edition by Santrock

reduces pain by increased education on birthing without

disabilities, and breathing problems.

WHAT HAPPENS DURING THE POSTPARTUM PERIOD?

Santrock: Children, 13e IM-4 | 3

4.1 Discuss the stages, decisions involved, and transitions in birth.

Santrock: Children, 13e IM-4 | 5

a higher incidence of preterm birth.

Santrock: Children, 13e IM-4 | 6

2. The Benefits of Co-Bedding

Developmental Care/Co-bedding (2005). Retrieved June 28, 2005, from

Santrock: Children, 13e IM-4 | 10

Santrock: Children, 13e IM-4 | 11

Santrock: Children, 13e IM-4 | 12

Critique a Child Development Article

 The birthing process

Santrock: Children, 13e IM-4 | 13

2. Mothers and Fathers …The Same or Different?

Santrock: Children, 13e IM-4 | 14

Santrock: Children, 13e IM-4 | 15

Web Site Suggestions

Santrock: Children, 13e IM-4 | 16

Assets Available in Connect

Asset Type Asset Title Page Learning Objective

Santrock: Children, 13e IM-4 | 17

CHILDBIRTH EDUCATION AND PLANNING PROGRAMS

 Main Features—What claims does the program make to help women?

Method Main Features Time Involved Expense Your

Santrock: Children, 13e IM-4 | 18

CROSS-CULTURAL PRACTICES OF CHILDBIRTH

Santrock: Children, 13e IM-4 | 19

REFLECTING ON THE ANDREA YATES CASE

Santrock: Children, 13e IM-4 | 20

GENDER IN BIRTH ANNOUNCEMENTS

Gender Adjectives Images

Santrock: Children, 13e IM-4 | 21

Santrock: Children, 13e IM-4 | 22

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