Guidepost 1 How have customs surrounding childbirth changed?

• In Europe and the United States, childbirth before the nineteenth century took place in a manner much like that in some developing countries today. Birth was a female ritual, which occurred at home and was attended by a midwife. Pain relief was minimal, and risks for mother and baby were high.
• The development of the science of obstetrics professionalized childbirth. Births took place in hospitals, attended by physicians. Medical advancements dramatically improved safety.
• Today some woman again are choosing the "demedicalized" experience of home birth, but with the resources of medical science close at hand.

Guidepost 2 How does labor begin, and what happens during each of the four stages of childbirth?

• Birth normally occurs after a preparatory period of parturition and consists of four stages: (1) dilation of the cervix; (2) descent and emergence of the baby; (3) expulsion of the umbilical cord and the placenta; (4) contraction of the uterus and recovery of the mother.
• Electronic fetal monitoring is widely used (and may be overused) during labor and delivery. It is intended to detect signs of fetal distress, especially in high-risk births.

Guidepost 3 What alternative method and settings of delivery are available today?

• Nearly 25 percent of births in the United States are by cesarean delivery--an unnecessarily high rate, according to critics.
• Natural or prepared childbirths can minimize the need for pain-killing drugs and maximize parents' active involvement. Modern epidurals can give effective pain relief with smaller doses of medication than in the past.
• Delivery at home or in birth centers, and attendance by midwives, are alternatives to physician-attended hospital delivery for women with normal, low-risk pregnancies who want to involve family members to make the experience more intimate and personal. The presence of a doula can provide physical benefits as well as emotional support.

Guidepost 4 How do newborn infants adjust to life outside the womb?

• The neonatal period is a time of transition from intrauterine to extrauterine life. During the first few days, the neonate loses weight and then regains it: the lanugo (prenatal hair) falls off and the protective coating of vernix caseosa dries up. The fontanels (soft spots) in the scull close within the first 18 months.
• At birth, the circulatory, respiratory, gastrointestinal, and temperature regulation systems become independent of the mother's. If a newborn cannot start breathing within about five minutes, brain injury may occur.
• Newborns have a strong sucking reflex and secrete meconium from the intestinal tract. They are commonly subject to neonatal jaundice, due to immaturity of the liver.

Guidepost 5 How can we tell whether a baby is healthy and is developing normally?

• At 1 minute and 5 minutes after birth, a neonate's Apgar score can indicate how well he or she is adjusting to extraunterine life. The Brazelton Neonatal Assessment Scale can assess responses to the environment and predict future development.
• Neonatal screening is done for certain conditions, such as PKU and congenital hypothyroidism.

Guidepost 6 What complications of childbirth can endanger newborn babies, and what can be done to improve the chances of a positive outcome?

• A small minority of infants suffer lasting effects of birth trauma. Other complications include low birthweight and postmature birth.
• Low-birthweight babies may be either preterm (premature) or small-for-date (small-for-gestational age). Low birthweight is a major factor in infant mortality and can cause long-term physical and cognitive problems. Very-low-birthweight babies have a less promising prognosis than those who weigh more.
• A supportive postnatal environment and other protective factors often can improve the outcome for babies suffering from birth complications.

Guidepost 7 How do parents bond with their babies and respond to the baby's patterns of sleep and activity?

• Researchers following the ethological approach have suggested that there is a critical period for the formation of the mother-infant bond. However, research has not confirmed this hypothesis. Fathers typically bond with their babies whether or not they are present at the birth.
• A newborn's state of arousal is governed by periodic cycles of wakefulness, sleep and activity, which seem to be inborn. Sleep takes up the major, but a diminishing, amount of a neonate's time. Newborns' activity levels show stability and may be early indicators of temperament. Parents' responsiveness to babies' states and activity is an important influence on development.

Guidepost 8 How does parenthood change the parents' relationship with one another?

• Marital satisfaction typically declines during the childraising years. Expectations and sharing of tasks can contribute to a marriage's deterioration of improvement.