Child Development

• Midwives are better trained today than ever and
  often go through intensive university-based
  classes in physiology and obstetrics.


• The role of technology in childbirth has been
  questioned in that it tends to be dehumanizing.
  Midwives are less likely to resort to such tech-
  niques, which in some cases may present more
  dangers to the woman and the infant than not.


• The federal government endorses the use of
  midwives and encourages institutions to employ
  them.
  Perhaps the best combination is a midwife work-
  ing directly with a physician so there is adequate tech-
  nical backup if necessary.

Complications

Most ‘‘complications’’ can usually be dealt with
successfully by the obstetrician and the hospital staff.
The baby may, for example, come out bottom first in
what is called a breech presentation. Sometimes one
foot is first to appear, and sometimes the umbilical
cord comes out alongside the head. The doctor must
manage these variations and often actually turn the
baby before birth with great skill to avoid any further
complications.

Babies, for the most part, deliver themselves. It
is when complications develop that the training and
expertise of the health-care provider are needed. The
fetal heartbeat is monitored during labor, and when
there is cause for concern, a cesarean delivery may
need to be performed.

A cesarean birth is one in which the baby is deliv-
ered through a surgical incision made into the
woman’s abdomen and uterus. Although it is general-
ly considered a safe operation for both mother and
baby, it is still major surgery. Babies delivered by ce-
sarean do not have molded heads and look better in
general than babies born vaginally. A cesarean deliv-
ery might be performed for reasons such as difficult
and perhaps dangerous labor, fetal distress, breech
presentation, and previous cesareans. These reasons
explain some 50 percent of all cesareans being per-
formed. As a rule, a cesarean delivery is planned
ahead of time and performed before labor has a
chance to begin. Today it can be performed even after
the uterine contractions have started if the child can-
not be delivered otherwise.

Another means of helping nature during birth is
through a tonglike instrument, known as forceps.
These concave, elongated tools are inserted as two
separate units into the vagina. Each is placed on the
baby’s head. When the handles are joined, the baby
be rotated and pulled.

A forceps delivery may be required if the moth-

er’s contractions slow down or stop. Today, hormones

are usually given to make the contractions continue.

But danger signs from either fetus or expectant moth-

er could call for delivery with forceps.

The use of forceps either in the first stage of deliv-

ery or early second stage can cause brain damage to

the child. At these stages it is important to place the

forceps accurately on the child’s head. It is also neces-

sary to use considerable force to pull the baby’s head

out. This is called high forceps delivery and is almost

never used today because of the danger involved. Low

forceps delivery, that is, the use of forceps in the actu-

al delivery stage, is rarely damaging to the child and

is still commonly used in many hospitals.

See also: CESAREAN DELIVERY; PREGNANCY;

PRENATAL DEVELOPMENT

Bibliography

Goer, Henci. The Thinking Woman’s Guide to a Better Birth. New

York: Berkley, 1999.

Leiter, Gila, and Rachel Kranz. Everything You Need to Know to Have

a Healthy Twin Pregnancy. New York: Dell, 2000.

Mahler, Margaret S., Fred Pine, and Anni Bergman. The Psychologi-

cal Birth of the Human Infant: Symbiosis and Individuation. New

York: Basic Books, 2000.

Simkin, Penny. The Birth Partner Cambridge, MA: Harvard Com-

mon Press, 2001.

Stoppard, Miriam. Conception, Pregnancy, and Birth. New York: Dor-

ling Kindersley, 2000.

Neil J. Salkind

BIRTH DEFECTS

A birth defect is an abnormality, present at birth, of

the structure, function, or metabolism of a part of the

body. Almost 150,000 babies are born each year with

a birth defect. There are more than 4,000 known

birth defects, which, when taken together, are the

leading cause of infant death in the United States.

Causes of Birth Defects

Although the causes of most birth defects are un-

known, many are attributable to a combination of fac-

tors. Some birth defects are the result of genetic

determinants, such as an abnormality due to an in-

herited trait or a problem with a gene or chromo-

some. For instance, researchers have linked various

physical malformations, metabolic abnormalities, cer-

tain vision and hearing losses, and other birth defects

to specific genes that are inherited from one (or in

rare cases, both) parent. Problems may also arise from

defects in a gene or chromosome structure or num-

ber. Down syndrome, which may lead to mental retar-

BIRTH DEFECTS 55