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Birth

A New Stage of Development

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Birth
Image: Jenny Erickson

Once the fetus has reached full-term, it is time for make that first big appearance into the world. In a normal, uncomplicated birth, the fetal brain first signals the release of hormones that then pass into the mother's bloodstream. These hormones cause the mother's uterine muscles to contract and relax, first in an irregular pattern but gradually becoming more and more regular.

During this first stage of labor, these uterine contractions gradually push the fetus downward, placing pressure on the cervix and causing it to dilate until it opens to about 10 centimeters (about 4 inches) in order to allow the fetus's head to pass through. The next stage is a brief period known as transition in which the baby's head moves into the birth canal.

Finally, in the second stage of labor, the baby's head crowns at the opening of the vagina. In most cases, less than an hour after crowing the head will finally emerge completely. Since the head is the largest part of the baby, the rest of the infant's body follows quickly.

How Newborns Are Assessed

In those first few magical moments after birth, both parents may marvel at the astonishing feat they have just accomplished and admire the new creature they have just brought into the world. Most babies begin to cry almost immediately and the circulatory system begins to function. As oxygen rushes through the body, the baby's skin will quickly turn from a slightly blue tinge to a rosy pink.

For the medical personal attending to the birth, those first few moments of life are a time of conducting important assessments to ensure that the infant is healthy. The umbilical cord is cut, any mucus is quickly removed from the mouth and throat, and the infant is wiped clean of any blood or other fluids. If the delivery occurs in a medical setting or if a trained health worker is present, the child's body functioning will be immediately assessed.

One of the most common ways to assess newborns is known as the Apgar scale, a quick and easy to perform method to evaluate the health of a newborn baby. The score is determined using five basic criteria that are rated on a scale from zero to two. The scores for each criterion are then summed, so an Apgar score can range from zero to 10. You can see an example of the Apgar scale in the table below.

This assessment is performed at one minute after birth and again five minutes after birth. While infants may score low at the one-minute point, many rapidly improve and score much higher by the five-minute mark. If, however, the infant still scores below a seven at the five-minute scoring then assistance is needed to establish normal breathing. Those that score below a four on the second assessment are considered critical and in need of immediate medical attention in order to prevent respiratory distress or death. In cases where the Apgar score remains below a three between 10 to 30 minutes after birth, there is an increased risk of long-term neurological impairment.

It's important to remember that the Apgar test was designed to allow health care professionals to quickly determine whether or not a newborn infant needs additional medical intervention. It was never intended to make long-term predictions about a child's future health and development. Very few babies score a perfect 10, yet most are perfectly capable of handling life outside the womb.

More About Early Development

The Apgar Scale

Score Color Heartbeat Reflex Irritability Muscle Tone Breathing
0 Blue, pale Absent No response Limp, flaccid Absent
1 Body pink, extremities blue Slow, below 100 Grimace or feeble cries Week, inactive Slow, irregular
2 Entirely pink Rapid, over 100 Crying or pulling away Strong, active when stimulated Strong, baby is crying

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