MINUTE BY MINUTE ON THE DAY BY DAY

Geraldine Lux Flanagan September 22 1962

MINUTE BY MINUTE ON THE DAY BY DAY

Geraldine Lux Flanagan September 22 1962

MINUTE BY MINUTE ON THE DAY BY DAY

Geraldine Lux Flanagan

Birth is beautifully arranged by nature to bring together the needs of the baby and the capacity of the mother. It is well timed. The baby becomes mature enough to be born just when he is so large that the womb is stretched to its limits. Yet he is still barely small enough to get out through the narrow birth passage. He has no more room to move and no more room to grow.

The baby’s growth is actually arrested a few days before birth because he gets less food from the aging placenta. The aging of the placenta and the response of the womb muscles to the great stretching will now help to set in motion the spectacular process of labor and delivery.

When he is ready to be born, the baby may weigh less than six pounds or more than ten pounds, depending on his inherited body design and on the nourishment provided by his mother. If he weighs under five pounds and eight ounces, he is considered to be premature in development, regardless of his presumed age. If he weighs more than ten pounds, he is either too fat or postmature. His birth may have been delayed and he may be older than nine months. The average baby weighs a little over seven pounds and is twenty inches long. Boys are somewhat bigger than girls.

The head of the baby has a circumference about equal to that of

From The First Nine Months of Life, copyright /962 by Geraldine Lux Flanagan, by permission of Simon and Schuster. Incorporated.

THE DAY OF BIRTH

his shoulders or buttocks. It is usually a tight fit for the opening of the bone-enclosed outlet through which he must travel. Fortunately, the head of the baby has some "give." His skull is not yet fully solid. It is made up of five large bone plates, which are still separated and can be pushed together. Between the plates there are narrow spaces that expose the tough membrane, the dura mater (in Latin, hard mother) that protects the brain. The spaces between the bone plates are called the sutures because, months later, when the skull plates are solidly joined, the lines of juncture look just like a stitched seam. I he sutures of the newborn baby are also called fontanels (which means little fountains) because the pulsing of the baby's blood stream can be plainly felt over them. The best-known of the fontanels is the "soft spot" on top of the baby's head.

The fontanels give the head its needed flexibility. Just betöre, and especially during birth, when the head is pressed hard against the birth canal, it gradually becomes molded as the bone plates slide together and sometimes come to overlap slightly. The natural molding does not damage the brain. It safely reduces the diameter of the skull and gives it the characteristically elongated shape of the newborn head. A tew' days after birth the head will regain its rounded form.

Birth is never easy lor the baby. It may take less than an hour or it may last many hours. The average duration of the birth of a first baby is fourteen hours. The average duration of the birth of subsequent babies is eight hours. Dr. Samuel Reynolds, a biologist who has studied the mechanics of labor, has said that like the three R s ot education there are three P's of labor. They are: the Passage, the Passenger and the Power. To these, one might add another: Psychology. Certainly, attitudes arc involved in the progress of birth. The length of labor, the

welfare of passenger and mother will depend

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continued from pape 29

"The first few breaths of air are the most difficult in life”

on these three, and perhaps four, P‘s.

The first thing that happens in birth, sometimes shortly before, is a narrowing of the uterus, which results in straightening the baby's body so that his head (or, in a few cases, his buttocks) is pressed against the outlet of the womb, called the cervix (in Latin, neck). Next, the virtually closed cervix must give way to accommodate the width of the baby's head. It has been established that the muscles of the top of the uterus apply a force comparable to a weight of fifty-five pounds to the baby with each contraction. Usually, the amnion ruptures under this pressure and, depending on the size and location of the tear, the fluid either rushes or trickles out. The contractions, coming at increasingly frequent intervals, push the baby against the cervix until the passively resisting muscles of this outlet give way and the head of the baby can slip out as through a tight bathing cap.

This completes the first and longest stage of birth. The second stage is quicker but requires much greater force. To move the baby out to his crowning, as the birth of the head is called, a force equal to a weight of nearly one hundred pounds is needed. The extra power must be supplied by the efforts of the mother. This is why the process of birth is called "labor." When the mother's muscle power, for various reasons, is not sufficient, the physician must help. He must work to bring the baby out by the pull of forceps or sometimes even by Caesarean birth. Both can be lifesaving procedures but they are not preferable to the more gentle process, of nature.

The baby's condition in birth will he quite parallel to that of his mother. If she has a difficult time, he will also. If she is groggy from medication, he will have received the medication through the placenta, and he will be a sleepy baby. If she is wide awake, he will be too. He will make continuing breathing efforts on his way out and will breathe on his own and be lively on arrival.

The first breaths of air are the hardest in life. It has been calculated that the first breathing-in requires five times the effort of an ordinary breath

because the air must be drawn in to expand the thousands of tiny uninflated air sacs of the lungs. It is an effort that can be compared to blowing up a rubber balloon. Breathing only gradually becomes easier. It continues to be irregular for two or three days. It takes that long to clear the air passages of mucus. For this the early cries are useful, for they help to clear out obstructing fluids. The cries may be a reflex response or they may be an expression of the baby’s discom-

fort. He has good reason to be uncomfortable. He is wet and he has just come into a room that is about twenty degrees colder than the ninetyeight-degree womb. It is also bright after the darkness and his eyes, although they are still in poor focus, can distinguish light.

At the same time, major adjustments take place in the baby's body as the route of his blood circulation changes radically. His blood stops flowing through the umbilical cord as

soon as the cord is born. As he draws fhs first breath, his heart must begin to pump blood to the lungs to pick up oxygen. Now' a major valve must close inside the heart to keep used and fresh blood separated.

The baby must begin to breathe and get his oxygen within minutes after birth. He receives the last oxygenladen blood from the placenta as he emerges. The circulation is cut off in the umbilical cord when it is exposed to air. Nature closes the cord through

a special jellylike substance that packed around the three blood vessels in the cord. 'I his jelly swells up with exposure to air and compresses the embedded vessels just as a tourniquet would. When the physician cuts the cord, it is a practically bloodless cut done only for convenience. The whole cord, with the placenta attached at its far end. would dry up and drop off naturally within a week or so, leaving the usual healed scar, our navel. The placenta is usually born very soon after the baby. It is detached from its moorings as the uterus rapidly contracts in size. Cord and placenta have outlived their usefulness at birth.

One of the pleasant aspects of the baby in birth is that he arrives quite clean. He is wet from the amniotic waters but not bloody. The first thing the mother traditionally looks for is to see whether her baby is a boy or girl. Whether boy or girl, she will find that the external organs of sex are swollen. In a boy only the scrotum will be swollen: in a girl the lips of the vulva. This is an inconsequential and only very short-lasting effect of the long umbilical relationship the baby has had with the mother. The special hormones of pregnancy that were circulating through her blood stream were shared to some extent by the baby. Those hormones that made her birth canal more elastic have made the baby’s genital tissue distended. Other hormones that stimulated the enlargement of the mother’s breasts and prepared them for milk production have stimulated the baby's breasts. Boys and girls alike actually have milk in their breasts for a few days after birth. This is called “witches' milk" and it sometimes drips from the nipples of the newborn. Thus, even boys have working mammary glands at one time in their lives.

From the womb the baby will bring with him some vernix cream still collected in the pockets of his skin folds. He may still have some downy lanugo hairs on his forehead, back or shoulders. These will fall out soon. His skin will be light, regardless of his race. Negro babies and all other babies are light at birth. The pigments that color

the skin are not yet in force and will not be for several days or even weeks. His abdomen is big and round because his liver is large from the special functions it has had in the production of blood cells. His nose may be runny from accumulated amniotic fluid. His ears are plugged with mucus so that he cannot hear. The mucus will clear out in a day or so. and then his hearing will be supersensitive for a while. His face may have some scratch marks from his own long fingernails, which will probably be in need of immediate trimming. His eyes will have no tears, no functioning tear ducts for several weeks. The first cries are always tearless ones. His eyes open and close and move about at random, sometimes staring, then again scanning the scene, often with some lack of co-ordination so that, at times, the baby may look wall-eyed or cross-eyed. He can distinguish light and dark and secs something of large shapes and moving objects.

From the womb the baby may bring the habit of sucking his thumb. He is able to suck vigorously now. If anything touches his checks, fat from well-developed suck-pad muscles, he will turn toward it and seek food. If anything touches the palm of his hand, his fingers close down in such a tight grip that he could even support his own weight if suspended by his hands. If his feet touch solid ground while his body is firmly supported, he will make stepping movements that are often mistaken for precocious walking. If he is laid on his tummy, he will make some swimminglike, primitive crawling efforts.

It is surprising how soon after the first shock of birth the baby begins to act thoroughly at home in his new' environment. As soon as he is dried and warmly w'rapped in a blanket, he will cough and yawn and sneeze and ogle his new' world. If put to his mother's breast he tries to suckle and usually succeeds soon. Then his liveliness subsides: he draws up his legs and arms to the position he favored in the womb and drops off into a very long, sound sleep to recover from this hard day. ★