The Newborn

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Chapter 7 The Newborn

John Olsson

The newborn (neonatal) period begins at birth (regardless of gestational age) and includes the 1st mo of life. During this time, marked physiologic transitions occur in all organ systems, and the infant learns to respond to many forms of external stimuli. Because infants thrive physically and psychologically only in the context of their social relationships, any description of the newborn’s developmental status has to include consideration of the parents’ role as well.

Parental Role in Maternal-Infant Attachment

Parenting a newborn infant requires dedication because a newborn’s needs are urgent, continuous, and often unclear. Parents must attend to an infant’s signals and respond empathically. Many factors influence parents’ ability to assume this role.

Prenatal Factors

Pregnancy is a period of psychologic preparation for the profound demands of parenting. Women may experience ambivalence, particularly (but not exclusively) if the pregnancy was unplanned. If financial worries, physical illness, prior miscarriages or stillbirths, or other crises interfere with psychologic preparation, the neonate may not be welcomed. For adolescent mothers, the demand that they relinquish their own developmental agenda, such as an active social life, may be especially burdensome.

The early experience of being mothered may establish unconsciously held expectations about nurturing relationships that permit mothers to “tune in” to their infants. These expectations are linked with the quality of later infant-parent interactions. Mothers whose early childhoods were marked by traumatic separations, abuse, or neglect may find it especially difficult to provide consistent, responsive care. Instead, they may reenact their childhood experiences with their own infants, as if unable to conceive of the mother-child relationship in any other way. Bonding may be adversely affected by several risk factors during pregnancy and in the postpartum period, which undermine the mother-child relationship and may threaten the infant’s cognitive and emotional development (Table 7-1).

Table 7-1 PRENATAL RISK FACTORS FOR ATTACHMENT

Recent death of a loved one
Previous loss of or serious illness in another child
Prior removal of a child
History of depression or serious mental illness
History of infertility or pregnancy loss
Troubled relationship with parents
Financial stress or job loss
Marital discord or poor relationship with the other parent
Recent move or no community ties
No friends or social network
Unwanted pregnancy
No good parenting model
Experience of poor parenting
Drug and/or alcohol abuse
Extreme immaturity

From Dixon SD, Stein MT: Encounters with children: pediatric behavior and development, ed 3, St Louis, 2000, Mosby, p 74.

Social support during pregnancy, particularly support from the father and close family members, is also important. Conversely, conflict with or abandonment by the father during pregnancy may diminish the mother’s ability to become absorbed with her infant. Anticipation of an early return to work may make some women reluctant to fall in love with their babies due to anticipated separation. Returning to work should be delayed at least until after 6 wk, when feeding and basic behavioral adjustments have been established.

Many decisions have to be made by parents in anticipation of the birth of their child. The most important choice is that of how the infant will be nourished. Among the important benefits of breast-feeding is the role of promoting bonding. Providing breast-feeding education for the parents at the prenatal visit by the pediatrician and by the obstetrician during prenatal care can increase maternal confidence in breast-feeding after delivery and reduce stress during the newborn period (Chapter 42).

Peripartum and Postpartum Influences

The continuous presence during labor of a woman trained to offer friendly support and encouragement (a doula) results in shorter labor, fewer obstetric complications (including cesarean section), and reduced postpartum hospital stays. Early skin-to-skin contact between mothers and infants immediately after birth may correlate with an increased rate and longer duration of breast-feeding. Most new parents value even a brief period of uninterrupted time in which to get to know their new infant, and increased mother-infant contact over the first days of life may improve long-term mother-child interactions. Nonetheless, early separation, although predictably very stressful, does not inevitably impair a mother’s ability to bond with her infant. Early discharge home from the maternity ward may undermine bonding, particularly when a new mother is required to resume full responsibility for a busy household.

Postpartum depression may occur in the 1st week or up to 6 mo after delivery and can adversely affect neonatal growth and development. Screening methods are available for use during neonatal and infant visits to the pediatric provider. Referral for care will greatly accelerate recovery (Table 7-2).

Table 7-2 EDINBURGH POSTNATAL DEPRESSION SCALE

INSTRUCTIONS FOR USERS

1 The mother is asked to underline the response that comes closest to how she has been feeling in the previous 7 days.
2 All 10 items must be completed.
3 Care should be taken to avoid the possibility of the mother discussing her answers with others.
4 The mother should complete the scale herself, unless she has limited English or has difficulty with reading.
5 The Edinburgh Postnatal Depression Scale may be used at 6-8 weeks to screen postnatal women. The child health clinic, a postnatal checkup, or a home visit may provide a suitable opportunity for its completion.

Edinburgh Postnatal Depression Scale

Name:

Address:

Baby’s age:
________________________________________________________________________________________________________________________________

Because you have recently had a baby, we would like to know how you are feeling. Please underline the answer that comes closest to how you have felt in the past 7 days, not just how you feel today.
________________________________________________________________________________________________________________________________

Here is an example, already completed.

I have felt happy:

Yes, all the time

Yes, most of the time

No, not very often

No, not at all

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