Infants and Children in Context. Tara L. Kuther

is unlikely to encounter problems requiring intervention—and may be a good candidate for a home birth (Wilbur, Little, & Szymanski, 2015). Although unpredictable events can occur and immediate access to medical facilities can improve outcomes, studies from Europe indicate that home birth is not associated with greater risk of perinatal mortality. However, home birth is far more common in many European countries than the United States (20% in the Netherlands, 8% in the United Kingdom, and about 1% in the United States) (Brocklehurst et al., 2011; de Jonge et al., 2015). The few U.S. studies that have examined planned home birth compared with hospital birth have found no difference in neonatal deaths or Apgar scores, and women who have a planned home birth report high rates of satisfaction (Jouhki, Suominen, & Åstedt-Kurki, 2017; Zielinski, Ackerson, & Kane Low, 2015). Cultures vary in their approach to birth, as discussed in the Lives in Context feature.

      Lives in Context: Cultural Context

      Cultural Differences in Childbirth

      Societies vary in their customs and perceptions of childbirth, including the privacy afforded to giving birth and how newborns are integrated into the community. In the United States, birth is a private event that usually occurs in a hospital, attended by medical personnel and one or two family members. In most cases, the first-time mother has never witnessed a birth but is well educated and may have well-informed expectations. After birth, the mother and infant are often visited by family within designated hospital visiting hours; the newborn usually rooms with the mother all or part of the day.

      A midwife prepares a mother to give birth in her home. Birth practices vary by culture.

      Liba Taylor / Alamy Stock

      In a small village in southern Italy, birth is a community event. It usually takes place in a hospital, attended by a midwife (Fogel, 2007; Schreiber, 1977). Just after birth, the midwife brings the mother’s entire family (immediate and extended) to the mother’s room and they take turns congratulating the mother and baby, kissing them. The family provides a party, including pastries and liqueurs. During labor and afterward, the mother is supported and visited by many of her friends and relatives to recognize the contribution that the mother has made to the community. The mother-in-law is an example of the social support system in place because a few days before and until about 1 month after the birth, she brings and feeds the mother ritual foods of broth, marsala, and fresh cheeses.

      In some other cultures, birth is an even more public process. The Jahara of South America give birth under a shelter in full view of everyone in the village (Fogel, 2007). On the Indonesian island of Bali, it is assumed that the husband, children, and other family will want to be present. The birth occurs in the home with the aid of a midwife and female relatives. As a result, Balinese women know what to expect in giving birth to their first child because they have been present at many births (Diener, 2000). The baby is immediately integrated into the family and community as he or she is considered a reincarnated soul of an ancestor. Many kin are present to support the mother and baby since the child is considered to be related to many more people than its parents.

      Childbirth is tied to social status in the Brong-Ahafo Region in Ghana. After a delivery, women achieve a higher social position and can then give advice to other women (Jansen, 2006). Home deliveries are highly valued. The more difficult the delivery and the less skilled assistance she receives, the more respect a woman attains, the higher her position will be, and the more influence she has on the childbirth decisions of other women, such as whether to give birth at home or in a medical setting and how to combine traditional and modern practices (Bazzano, Kirkwood, Tawiah-Agyemang, Owusu-Agyei, & Adongo, 2008).

      Many cultures conduct rites that they believe protect newborns from evil and spirits. Among the Maya of the Yucatan region of Mexico, there are few changes in the expectant mother’s surroundings; the Mayan woman lies in the same hammock in which she sleeps each night. The father-to-be is expected to be present during labor and birth to take an active role but also to witness the suffering that accompanies labor. If the father is not present and the child is stillborn, it is blamed on the father’s absence. The pregnant woman’s mother is present, often in the company of other females, including sisters, sisters-in-law, mothers-in-law, godmothers, and sometimes neighbors and close friends. The mother and child must remain inside the house for 1 week before returning to normal activity after birth because it is believed that the mother and newborn are susceptible to the influence of evil spirits from the bush (Gardiner & Kosmitzki, 2018).

      A neighboring ethnic group, the Zinacanteco, place their newborns naked before a fire. The midwife who assisted the mother says prayers asking the gods to look kindly upon the infant. The infant is dressed in a long skirt made of heavy fabric extending beyond the feet; this garment is to be worn throughout the first year. The newborn is then wrapped in several layers of blankets, even covering the face, to protect against losing parts of the soul. These traditional practices are believed to protect the infant from illnesses as well as evil spirits (Brazelton, 1977; Fogel, 2007).

      What Do You Think?

      1 Which of these birthing customs most appeals to you? Why?

      2 If you, a family member, or friend have given birth, describe the process. Where did the birth occur? Who witnessed it? What happened afterward? When did family and friends meet the baby? ●

      Thinking in Context 3.3

      1 How might contextual issues influence parents’ decisions about birthing? How might contextual factors account for differences in the rates of home birth, natural birth, and cesarean birth?

      2 Create a birth plan for a healthy woman in her 20s. What type of birth will you choose? Why? How might you address pain relief? Consider a healthy 39-year-old woman. In what ways might your birth plan change (or not)? Why?

      The Newborn

      The average newborn is about 20 inches long and weighs about 7½ pounds. Boys tend to be slightly longer and heavier than girls. Newborns have distinctive features, including a large head (about one-quarter of body length) that is often long and misshapen from passing through the birth canal. The newborn’s skull bones are not yet fused—and will not be until about 18 months of age—permitting the bones to move and the head to mold to the birth canal, easing its passage. A healthy newborn is red-skinned and wrinkly at birth; skin that is bluish in color indicates that the newborn has experienced oxygen deprivation. Some babies emerge covered with lanugo, the fuzzy hair that protects the skin in the womb; for other babies, the lanugo falls off prior to birth. The newborn’s body is covered with vernix caseosa, a white waxy substance that protects against infection; this dries up within the first few days. Although many hospital staff wash the vernix caseosa away after birth, research suggests that it is a naturally occurring barrier to infection and should be retained at birth (Jha et al., 2015).

      Medical and Behavioral Assessment of Newborns

      After birth, newborns are routinely screened with the Apgar scale, which provides a quick and easy overall assessment of the baby’s immediate health. As shown in Table 3.1, the Apgar scale is composed of five subtests: appearance (color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (breathing). The newborn is rated 0, 1, or 2 on each subscale for a maximum total score of 10. A score of 4 or lower means that the newborn is in serious condition and requires immediate medical attention. The rating is conducted twice, 1 minute after delivery and again 5 minutes after birth; this timing ensures that hospital staff will monitor the newborn over several minutes. Over 98% of all newborns in the United States achieve a 5-minute score of 7 to 10, indicating good health (Martin, Hamilton, Osterman, Curtin, & Mathews, 2013).

      The Brazelton Neonatal Behavioral Assessment Scale (NBAS) is a neurobehavioral assessment commonly administered to newborns, especially those who are judged to be