Infancy and Childhood
Readings and Resources
Readings and Resources
eBook:
Zastrow, C., Kirst-Ashman, K.K. & Hessenauer, S.L. (2019). Empowerment series: Understanding human behavior and the social environment (11th Ed.). Cengage Learning.
· Chapter 2: Biological Development in Infancy and Childhood
· Chapter 3: Psychological Development in Infancy and Childhood
· Chapter 4: Social Development in Infancy and Childhood
Articles, Websites, and Videos:
Erik Erikson is a well-known Psychologist and Psychoanalyst known who devoted his work to understanding the psychosocial development of individuals. This video explains the 8 stages of psychosocial development and reviews Erikson’s beliefs on how all of us move through these stages in our lifespan. https://youtu.be/04wbdxzkvYU
Doesn’t everyone like to play with children? Do we understand the multiple benefits of play? In this video, play is examined emphasizing how it supports responsive relationships, strengthens core life skills and reduces sources of stress for young children . https://youtu.be/pjoyBZYk2zI
A child’s temperament can affect many aspects of their lives. This video examines the three major temperament styles of children, including descriptions of their behaviors, and identifies which parenting style is the best for a particular child and their temperament. https://youtu.be/uDNmTn2s8_w
Chapter 2 Biological Development in Infancy and Childhood
Chapter Introduction
Camille Tokerud/Taxi/Getty Images
Learning Objectives
This chapter will help prepare students to
EP 6a
EP 7b
EP 8b
· LO 1 Describe the dynamics of human reproduction (including conception, the diagnosis of pregnancy, fetal development, prenatal influences and assessment, problem pregnancies, and the birth process)
· LO 2 Explain typical developmental milestones for infants and children
· LO 3 Examine the abortion controversy (in addition to the impacts of social and economic forces)
· LO 4 Explain infertility (including the causes, the psychological reactions to infertility, the treatment of infertility, the assessment process, alternatives available to infertile couples, and social work roles concerning infertility)
Juanita lovingly watched her 1-year-old Enrico as he lay in his crib playing with his toes. Enrico was her first child, and Juanita was very proud of him. She was bothered, however, that he could not sit up by himself. Living next door was a baby about Enrico’s age, whose name was Teresa. Not only could she sit up by herself, but she could crawl, stand alone, and was even starting to walk. Juanita thought it was odd that the two children could be so different and have such different personalities. That must be the reason, she thought. Enrico was just an easygoing child. Perhaps he was also a bit stubborn. Juanita decided that she wouldn’t worry about it. In a few weeks, Enrico would probably start to sit up.
Knowledge of typical human development is critical in order to understand and monitor the progress of children as they grow. In this example, Enrico was indeed showing some developmental lags. He was in need of an evaluation to determine his physical and psychological status so that he might receive help.
A Perspective
The attainment of typical developmental milestones has a direct impact on the client. Biological, psychological, and social development systems operate together to affect behavior. This chapter will explore some of the major aspects of infancy and childhood that social workers must understand in order to provide information to clients and make appropriate assessments of client behavior.
2-1 Describe the Dynamics of Human Reproduction
LO 1
Chuck and Christine had mixed emotions about the pregnancy. It had been an accident. They were both in their mid-30s and already had a vivacious 4-year-old daughter named Hope. Although Hope had been a joy to both of them, she had also placed serious restrictions on their lifestyle. They were looking forward to her beginning school. Christine had begun to work part-time and was planning to go full-time as soon as Hope turned 5.
Now all that had changed. To complicate the matter, Chuck, a university professor, had just received an exciting job offer in Hong Kong—the opportunity of a lifetime. They had always dreamed of spending time overseas.
The unexpected pregnancy provided Chuck and Christine with quite a jolt. Should they terminate the pregnancy and go on with their lives in exotic Hong Kong? Should they have the baby overseas? Questions concerning foreign prenatal care, health conditions, and health facilities flooded their thoughts. Would it be safer to remain in the United States and turn down this golden opportunity? Christine was 35. Her reproductive clock was ticking away. Soon risk factors concerning having a healthy, normal baby would begin to skyrocket. This might be their last chance to have a second child. Chuck and Christine did some serious soul-searching and fact-searching to arrive at their decision.
Yes, they would have the baby. Once the decision had been made, they were filled with relief and joy. They also decided to take the job in Hong Kong. They would use the knowledge they had about prenatal care, birth, and infancy to maximize the chance of having a healthy, normal baby. They concluded that this baby was a blessing who would improve, not impair, the quality of their lives.
The decision to have children is a serious one. Ideally, a couple should examine all alternatives. Children can be wonderful. Family life can bring pleasurable activities, pride, and fullness to life. On the other hand, children can cause stress. They demand attention, time, and effort and can be expensive to care for. Information about conception, pregnancy, birth, and child rearing can only help people make better, more effective decisions.
2-1aConception
Sperm meets egg; a child is conceived. But in actuality, it is not quite that simple. Many couples who strongly desire to have children have difficulty conceiving. Many others whose last desire is to conceive do so with ease. Some amount of chance is involved.
Conception refers to the act of becoming pregnant. Sperm need to be deposited in the vagina near the time of ovulation. Ovulation involves the ovary’s release of a mature egg into the body cavity near the end of one of the fallopian tubes. Fingerlike projections called fimbriae at the end of the fallopian tube draw the egg into the tube. From there, the egg is gently moved along inside the tube by tiny hairlike extensions called cilia. Fertilization actually occurs in the third of the fallopian tube nearest the ovary.
If a sperm has gotten that far, conception may occur. After ejaculation, the discharge of semen by the penis, the sperm travels up into the uterus and through the fallopian tube to meet the egg. Sperm are equipped with a tail that can lash back and forth, propelling them forward. The typical ejaculate, an amount of approximately one teaspoon, usually contains 200 to 400 million sperm; however, only 1 in 1,000 of these will ever make it to the area immediately surrounding the egg (Rathus, Nevid, & Fichner-Rathus, 2014). Unlike females, who are born with a finite number of eggs, males continually produce new sperm. Fertilization is therefore quite competitive. It is also hazardous. The majority of these sperm don’t get very far (Hyde & DeLamater, 2017; Rathus et al., 2014). Many spill out of the vagina, drawn by gravity. Others are killed by the acidity of the vagina. Still others swim up the wrong fallopian tube, meaning the one without the egg. Only about 2,000 sperm make it up the right tube. By the time a sperm reaches the egg, it has swum a distance 3,000 times its own length; an equivalent swim for a human being would be more than 3 miles (Hyde & DeLamater, 2017).
Although sperm are healthiest and most likely to fertilize an egg during the first 24 hours after ejaculation, they may survive up to 72 hours in a woman’s reproductive tract; an egg’s peak fertility is within the first 8 to 12 hours after ovulation, although it may remain viable for fertilization for up to 24 hours, and some may remain viable for up to five days (Greenberg, Bruess, & Oswalt, 2017; Newman & Newman, 2015). Therefore, sexual intercourse should ideally occur not more than five days before or one day after ovulation for fertilization to take place (Yarber & Sayad, 2016).
In the fallopian tube, the egg apparently secretes a chemical substance that attracts sperm. The actual fertilization process involves sperm reaching the egg, secreting an enzyme, and depositing it on the egg. This enzyme helps dissolve a gelatinous layer surrounding the egg and allows for the penetration of a sperm. After one sperm has penetrated the barrier, the gelatinous layer undergoes a physical change, thus preventing other sperm from entering it.
Fertilization occurs during the exact moment the egg and sperm combine. Eggs that are not fertilized by sperm simply disintegrate. The genetic material in the egg and sperm combine to form a single cell called a zygote.
Eggs contain an X chromosome. Sperm may contain either an X or a Y chromosome. Eggs fertilized by a sperm with an X chromosome will result in a female; those fertilized by sperm with a Y chromosome will result in a male.
The single-celled zygote begins a cell division process in which the cell divides to form two cells, then four, then eight, and so on. Within a week, the new mass of cells, called a blastocyst, attaches itself to the lining of the uterus. If attachment does not occur, the newly formed blastocyst is simply expelled. From the point of attachment until eight weeks of gestation, the conceptus, or product of conception, is called an embryo. From eight weeks until birth, it is referred to as a fetus. Gestation refers to the period of time from conception to birth.
2-1bDiagnosis of Pregnancy
Pregnancy can be diagnosed by using laboratory tests, by observing the mother’s physical symptoms, or by performing a physical examination. Early symptoms of pregnancy can include increase in basal body temperature that lasts for up to 3 weeks, breast tenderness, feelings of fatigue, and nausea (Hyde & DeLamater, 2017). Many women first become aware of the pregnancy when they miss a menstrual period. However, women also can miss periods as a result of stress, illness, or worry about possible pregnancy. Some pregnant women will even continue to menstruate for a month or even more. Therefore, lab tests are often needed to confirm a pregnancy. Such lab tests are 98 to 99 percent accurate and can be performed at a Planned Parenthood agency, a medical clinic, or a physician’s office (Hyde & DeLamater, 2017; Rathus et al., 2014).
Most pregnancy tests work by detecting human chorionic gonadotropin (HCG) in a woman’s urine or blood. HCG is a hormone secreted by the placenta (the tissue structure that nurtures a developing embryo). Laboratory tests can detect HCG as early as eight days after conception (Greenberg et al., 2014).
The use of home pregnancy tests (HPTs) has become quite common. Like some laboratory tests, they measure HCG levels in urine. They are very convenient, relatively inexpensive and can be used as early as the first day a menstrual period was supposed to start. However, they are more likely to be accurate if administered after more time has passed.
Most HPTs function in a similar fashion. The user holds a stick in the urine stream or collects urine in a cup and dips the stick into it. Most tests have a results window indicating whether a woman is pregnant or not. Most tests also stress retaking the test a few days or a week later to confirm its accuracy.
Because HCG increases as the pregnancy progresses, HPTs become more accurate as time goes on. “Many home pregnancy tests claim to be 99 percent accurate on the day you miss your period. Although research suggests that most home pregnancy tests don’t consistently spot pregnancy this early, home pregnancy tests are considered reliable when used according to package instructions one week after a missed period” (Mayo Clinic, 2013c).
Although HPTs can be highly accurate, there is room for error. If instructions are not followed perfectly, results can be faulty. For instance, exposure to sunlight, accidental vibrations, using an unclean container to collect urine, or examining results too early or too late all can end in an erroneous diagnosis. False negatives (i.e., showing that a woman is not pregnant when she really is) are more common than false positives (i.e., showing that a woman is pregnant when she really is not). Regardless, it is suggested that a woman confirm the results either by waiting a week and administering another HPT or by having a laboratory diagnosis performed. Early knowledge of pregnancy is important either to begin early health care or to make a decision about terminating a pregnancy.
2-1cFetal Development during Pregnancy
An average human pregnancy lasts about 266 days after conception (Papalia & Martorell, 2015). However, there is a great amount of variability in the length of pregnancies among mothers. It is most easily conceptualized in terms of trimesters, or three periods of three months each. Each trimester is characterized by certain aspects of fetal development.
The First Trimester
The first trimester is sometimes considered the most critical. Because of the embryo’s rapid differentiation and development of tissue, the embryo is exceptionally vulnerable to the mother’s intake of noxious substances and to aspects of the mother’s health.
By the end of the first month, a primitive heart and digestive system have developed. The basic initiation of a brain and nervous system is also apparent. Small buds that will eventually become arms and legs are appearing. In general, development starts with the brain and continues down through the body. For example, the feet are the last to develop. In the first month, the embryo bears little resemblance to a baby because its organs have just begun to differentiate.
The embryo begins to resemble human form more closely during the second month. Internal organs become more complex. Facial features including eyes, nose, and mouth begin to become identifiable. The 2-month-old embryo is less than an inch long and weighs about one-third of an ounce.
The third month involves the formation of arms, hands, legs, and feet. Fingernails, hair follicles, and eyelids develop. All the basic organs have appeared, although they are still underdeveloped. By the end of the third month, bones begin to replace cartilage. Fetal movement is frequently detected at this time.
During the first trimester, the mother experiences various symptoms. This is primarily due to the tremendous increase in the amount of hormones her body is producing. Symptoms frequently include tiredness, breast enlargement and tenderness, frequent urination, and food cravings. Some women experience nausea, referred to as morning sickness.
It might be noted that these symptoms resemble those often cited by women when first taking birth control pills. In effect, the pill, by introducing natural or artificial hormones that resemble those of pregnancy, tricks the body into thinking it is pregnant, thus preventing ovulation. The pill as a form of contraception is discussed more thoroughly in Chapter 6.
The Second Trimester
Fetal development continues during the second trimester. Toes and fingers separate. Skin, fingerprints, hair, and eyes develop. A fairly regular heartbeat emerges. The fetus begins to sleep and wake at regular times. Its thumb may be inserted into its mouth.
For the mother, most of the unappealing symptoms of the first trimester subside. She is more likely to feel the fetus’s vigorous movement. Her abdomen expands significantly. Some women suffer edema, or water retention, which results in swollen hands, face, ankles, or feet.
The Third Trimester
The third trimester involves completing the development of the fetus. Fatty tissue forms underneath the skin, filling out the fetus’s human form. Internal organs complete their development and become ready to function. The brain and nervous system become completely developed.
An important concept that becomes relevant during the sixth and seventh months of gestation is viability. This refers to the ability of the fetus to survive on its own if separated from its mother. Although a fetus reaches viability by about the middle of the second trimester, many infants born at 22–25 weeks “do not survive, even with intensive medical care, and many of those who do experience chronic health or neurological problems” (Sigelman & Rider, 2012, p. 100).
The viability issue becomes especially critical in the context of abortion. The question involves the ethics of aborting a fetus that, with external medical help, might be able to survive. This issue underscores the importance of obtaining an abortion early in the pregnancy when that is the chosen course of action.
For the mother, the third trimester may be a time of some discomfort. The uterus expands, and the mother’s abdomen becomes large and heavy. The additional weight frequently stresses muscles and skeleton, often resulting in backaches or muscle cramps. The size of the uterus may exert pressure on other organs, causing discomfort. Some of the added weight can be attributed to the baby itself, amniotic fluid, and the placenta. Other normal weight increases include those of the uterus, blood, and breasts as part of the body’s natural adaptation to pregnancy.
Pregnancy Apps
Many women now use technology as a way to get advice about their pregnancy and parenting. Mobile apps, such as “BabyBump Pregnancy,” “My Pregnancy & Baby Today,” “WebMD Pregnancy,” and “Parenting Tips,” help parents by providing information on subjects such as tracking your period, what to expect during your pregnancy, what your baby looks like in the womb (complete with pictures and photos), fetal development information, tips on how to have a healthy pregnancy, questions to ask at doctors’ appointments, contraction timing, and much more. For those who want up-to-date advice or information, an app might be a source of information to look into. It is important to note, however, that these apps should not be used as a substitute for the prenatal care given by a medical professional, especially for women with at-risk pregnancies.
2-1dPrenatal Influences
Numerous factors can influence the health and development of the fetus. These include the expectant mother’s nutrition, drugs and medication, alcohol consumption, smoking habits, age, stress, and a number of other factors.
Nutrition
A pregnant woman is indeed eating for two. In the past, pregnant women were afraid of gaining too much weight. But a woman should usually gain 25 to 35 pounds during her pregnancy (Berk, 2013; Kail & Cavenaugh, 2013; Sigelman & Rider, 2012). She typically requires 300 to 500 additional calories daily to adequately nurture the fetus (Papalia & Martorell, 2015).
The optimal weight gain depends on the woman’s height and her weight prior to pregnancy. For example, a woman who is underweight before pregnancy might require a greater weight gain to maintain a healthy pregnancy.
Being underweight or overweight poses risks to the fetus. Too little weight gain due to malnutrition can result in low infant birth weight, increased risk of mental or motor impairment, and a higher risk of infant mortality (Berk, 2013; Newman & Newman, 2015). Being overweight either before or during pregnancy can increase the risk of miscarriage and other complications during pregnancy and birth (Chu et al., 2008), in addition to birth defects (Stothard, Tenant, Bell, & Rankin, 2009).
Not only does a pregnant woman need to eat more, but the quality of food also needs careful monitoring and attention. It is especially important for pregnant women to get enough protein, iron, calcium, and folic acid (a B vitamin), in addition to other vitamins and minerals (Berk, 2013; Kail & Cavenaugh, 2013). As Hyde and DeLamater (2017) explain,
Protein is important for building new tissues. Folic acid is also important for growth; symptoms of folic acid deficiency are anemia [low red blood cell count] and fatigue. A pregnant woman needs much more iron than usual, because the fetus draws off iron for itself from the blood that circulates to the placenta. Muscle cramps, nerve pains, uterine ligament pains, sleeplessness, and irritability may all be symptoms of a calcium deficiency. (p. 127)
Drugs and Medication
Because the effects of many drugs on the fetus are unclear, pregnant women are cautioned to be wary of drug use. Drugs may cross the placenta and enter the bloodstream of the fetus. Any drugs should be taken only after consultation with a physician. The effects of such drugs usually depend on the amount taken and the gestation stage during which they are taken. This is especially true for the first trimester, when the embryo is very vulnerable.
Teratogens are substances, including drugs, that cause malformations in the fetus. Certain drugs can cause malformations of certain body parts or organs. The so-called thalidomide babies of the early 1960s provide a tragic example of the potential effects of drugs. Thalidomide, a type of tranquilizer used to ease morning sickness, was found to produce either flipper-like appendages in place of arms or legs, or no arms or legs at all.
A variety of prescription drugs can produce teratogenic effects. These include antibiotics such as tetracycline and streptomycin, Accutane (an acne drug), and some antidepressants (Rathus et al., 2014; Santrock, 2016). Generally speaking, women should avoid taking drugs or medications during pregnancy and while breastfeeding unless such medication is absolutely necessary.
Even nonprescription, over-the-counter drugs such as Aspirin (acetylsalicylic acid) or caffeine should be consumed with caution (Santrock, 2016). Aspirin can cause bleeding problems in the fetus (Steinberg et al., 2011a). Coffee, tea, colas, and chocolate all contain caffeine. The research findings concerning the effects of caffeine on a fetus have been mixed (Maslova, Bhattacharya, Lin, & Michels, 2010; Minnes, Lang, & Singer, 2011; Rathus, 2014a). However, some research results have revealed a greater risk of low birth weight (Rathus, 2014a; Santrock, 2016). Even vitamins should be consumed with care and only under a physician’s supervision (Rathus et al., 2014; Steinberg et al., 2011a). An expectant mother’s best bet is to be cautious.
Ethical Question 2.1
EP 1
1. Should a pregnant woman who consumes alcohol or illegal drugs that damage her child be punished as a criminal? Should her child be taken from her? If so, with whom should the child be placed?
Alcohol
Alcohol consumption during pregnancy can have grave effects on a fetus. The condition is termed fetal alcohol syndrome (FAS). Babies of women who were heavy drinkers during pregnancy have “unusual facial characteristics [including widely spaced eyes, short nose, and thin upper lip], small head and body size, congenital heart defects, defective joints, and intellectual and behavioral impairment” (Yarber & Sayad, 2016, p. 370). Effects stretch into childhood and even adulthood. They include difficulties in paying attention, hyperactivity, lower-than-normal intelligence, and significant difficulties in adjustment and social interaction (Shaffer & Kipp, 2010). The severity of defects increases with the amount of alcohol consumed during pregnancy (Shaffer & Kipp, 2010). However, there is evidence that even more moderate alcohol consumption, such as one or two drinks a day, can harm the fetus (Rathus et al., 2014; Shaffer & Kipp, 2010; Steinberg et al., 2011a). Fetal alcohol effects (FAE) is a condition that manifests relatively less severe (yet still significant) problems, presumably resulting from lower levels of alcohol consumption during pregnancy.
2-1eDrugs of Abuse
Illegal drugs, such as cocaine (a powerful stimulant) and heroin (an opioid), can cause significant problems during a pregnancy (Newman & Newman, 2015). Both of these substances can cause infertility, problems with the placenta resulting in the fetus not receiving enough food or oxygen, preterm labor, or death of the fetus via miscarriage or stillborn birth. Babies may be premature, or have low birth weight, heart defects, birth defects, or infections such as hepatitis or AIDS (March of Dimes, 2013). A significant problem is when the baby develops Neonatal Abstinence Syndrome (NAS). In NAS, the baby is born addicted to the addictive drugs the mother used during her pregnancy and goes through withdrawal at birth. These babies have a tendency to have lower birth weights, breathing problems, sleep difficulties, seizures, and birth defects, and may require a longer stay in the hospital. Signs and symptoms of NAS include body shakes, seizures, excessive crying, trouble sleeping, fever, inability to gain weight, and overall fussiness. All of these symptoms may need to be treated with medications, fluids, or higher-calorie feedings (March of Dimes, 2015).
Marijuana may also cause problems during a pregnancy (Papalia & Martorell, 2015). Studies link marijuana use with premature birth, low birth weight, increased chance of stillbirth, withdrawal symptoms in the baby, and problems with brain development (March of Dimes, 2016). Ingredients in marijuana can also pass to a child during breastfeeding; therefore, it is recommended that breastfeeding moms refrain from marijuana use (March of Dimes, 2016).
Note, however, that it is difficult to separate out the direct effects of specific drugs because of the numerous other factors involved (e.g., an impoverished environment or use of other potentially harmful substances by the mother).
Smoking
Numerous studies associate smoking with low birth weight, preterm births, breathing difficulties, fetal death, and crib death (Rathus, 2014a; Santrock, 2016; Shaffer & Kipp, 2010; Yarber & Sayad, 2013). Even secondhand smoke is thought to pose a danger to the fetus (Rathus, 2014a). Some research found a relationship between a mother’s smoking during pregnancy and a child having behavioral and emotional problems when the child reaches school age (Papalia & Martorell, 2017; Rathus, 2014a).
Studies have also found that a father’s smoking during pregnancy may affect the health of the child (Hyde & DeLamater, 2017).
Age
The pregnant woman’s age may affect both the woman and the child. Women “between ages 16 and 35 tend to provide a better uterine environment for the developing fetus and to give birth with fewer complications than do women under 16 or over 35” (Newman & Newman, 2015, p. 118). Women aged 35 and older account for more than 16 percent of all births in the United States (U.S. Census Bureau, 2011). For example, although a woman who is aged 16 to 34 has a very low risk of having a baby with Down syndrome, the likelihood increases to about 1 in 30 births once the mother reaches the age of 45 (Yarber & Sayad, 2016). It is thought that a contributing factor to Down syndrome is deterioration of the female’s egg or the male’s sperm as people age (Newman & Newman, 2015). Mothers aged 40 and over “are also at slightly higher risk for maternal death, premature delivery, cesarean sections, and low-birth-weight babies (London, 2004). As women age, chronic illnesses such as high blood pressure and diabetes may also present pregnancy- and birth-related complications” (Yarber & Sayad, 2013, p. 375).
Teen mothers account for about 24 births per 1,000 females in the United States in 2014 (LOC, 2016). Their infants have twice the mortality rates of infants born to mothers in their 20s (Santrock, 2016). Their infants are more likely to be underweight and experience a greater risk of health problems and disabilities (Papalia & Martorell, 2015). Problems are often due to an immature reproductive system, inadequate nutrition, poor or no prenatal care, and poverty (Santrock, 2016; Smithbattle, 2007).
Maternal Stress
Maternal stress is another factor that can affect fetal development (Kail & Cavenaugh, 2014; Rathus, 2014a). Bjorklund and Blasi (2014) explain:
Women who experience high levels of stress during pregnancy are more apt to have premature births and low-weight babies (Mulder [et al.], 2002). It is important to note that stress is not some phantom effect but quite real in its physical effects; it causes decreased nutrients and oxygen to the fetus and weakens the mother’s immune system, making the fetus more vulnerable as well. Stress in the mother can cause hormone imbalances in the placenta. In addition, women with high levels of stress are more apt to engage in behaviors that are harmful to the fetus, such as tobacco and alcohol use. (pp. 108–109)
Other Factors
Other factors have been found to affect prenatal and postnatal development. For example, lower income level and socioeconomic class can pose health risks to any mother and her fetus (Newman & Newman, 2015). Illness during pregnancy may damage the developing fetus. Rubella (German measles) can cause physical or mental disabilities in the fetus if a woman contracts it during the first three months of pregnancy (Yarber & Sayad, 2016). Prevention of rubella is possible by vaccination; however, this should not be done during pregnancy because it can harm the fetus.
Sexually transmitted infections (STIs) may also be transmitted from mother to newborn in the womb, during birth, or afterward. Pregnant women should be tested for “chlamydia, gonorrhea, hepatitis B, HIV, and syphilis” (described in Chapter 6; Yarber & Sayad, 2016, p. 371). Transmission can often be prevented or infants treated successfully. For example, acquired immune deficiency syndrome (AIDS), which is transmitted by the human immunodeficiency virus (HIV), can infect a fetus through the placenta; it can also infect an infant at birth if there is contact with the mother’s blood, or through breast milk. However, administration of certain drugs, such as azidothymidine (AZT), to the mother during pregnancy and to the infant after birth, in addition to performing a cesarean section (surgical removal of the infant from the womb), has radically decreased mother-to-infant HIV transmission rates in the United States (Santrock, 2016).
2-1fPrenatal Assessment
Tests are available to determine whether a developing fetus has any of a variety of defects. These tests include ultrasound sonography, fetal MRI, amniocentesis, chorionic villus sampling, and maternal blood tests.
“The development of brain imaging techniques has led to increasing use of fetal MRI to diagnose fetal malformations” (Schmid et al., 2011). “MRI (magnetic resonance imaging) uses a powerful magnet and radio images to generate detailed images of the body’s organs and structures” (Santrock, 2016, p. 61). Ultrasound sonography is generally the first and much more common option for fetal screening because it is cost effective and safe. However, when a clearer image or more information is required to provide an accurate diagnosis and effective treatment planning, an MRI can be used. Frequently, ultrasound sonography will identify a potential abnormality and a subsequent MRI will offer a more comprehensive, clearer picture of what’s involved (Mangione et al., 2011). “Among the fetal malformations that fetal MRI may be able to detect better than ultrasound sonography are certain central nervous system, chest, gastrointestinal, genital/urinary, and placental abnormalities” (Nemec et al., 2011; Triulzi, Managaro, & Volpe, 2011; Amini, Wikstrom, Ahlstrom, & Axelsson, 2011; Santrock, 2016, p. 61).
Amniocentesis involves the insertion of a needle through the abdominal wall and into the uterus to obtain amniotic fluid for determination of fetal gender or chromosomal abnormalities. The amniotic fluid contains fetal cells that can be analyzed for a variety of birth defects including Down syndrome, muscular dystrophy, and spina bifida. The gender of the fetus can also be determined. Amniocentesis is recommended if a woman has had a baby with a birth defect, may be a genetic carrier of such a defect, or is over age 35. A disadvantage of amniocentesis is that the test is usually performed about the 16th or 17th week of pregnancy (Charlesworth, 2014). Results are available in about 2 weeks after that (Santrock, 2016). If a serious problem is discovered, people don’t have much time to decide whether to terminate the pregnancy. Another danger is a small risk of miscarriage (Rathus, 2014a; Santrock, 2016).
Chorionic villus sampling (CVS) is another method of diagnosing defects in a developing fetus. It involves the insertion of a thin plastic tube through the vagina or a needle through the abdomen into the uterus. A sample of the chorionic villi (tiny fingerlike projections on the membrane that surrounds the fetus) is taken for analysis of potential genetic irregularities (National Institutes of Health [NIH], 2014). It can be performed between the 10th and 12th weeks of pregnancy, with results received within about two weeks (NIH, 2014). An advantage of CVS is that it can be done earlier in the pregnancy than amniocentesis. Couples may have a different perspective on whether to abort or keep a defective fetus at this early stage of the pregnancy. A disadvantage of CVS, as with amniocentesis, is an increased risk of miscarriage (Charlesworth, 2014; NIH, 2014; Rathus, 2014a).
Maternal blood tests done between the 16th and 18th weeks of gestation can detect a variety of conditions (Santrock, 2016). For instance, the amount of a substance called alpha-fetoprotein (AFP) can be measured. High levels of AFP forewarn about abnormalities of the brain and spinal cord. Testing AFP levels can also detect Down syndrome. Ultrasound sonography or amniocentesis can then be used to verify the presence of such congenital conditions.
A physician and pregnant mother examine an ultrasound of the fetus
Monkey Business Images/ Shutterstock.com
In addition to a pregnant woman’s behavior and condition, numerous other variables in the macro environment and in a woman’s personal situation also directly affect the fetal condition. Highlight 2.1 discusses how social workers can help pregnant women access and maximize the use of prenatal care.
Highlight 2.1
Social Workers Can Assist Women in Getting Prenatal Care: Implications for Practice
Prenatal care is considered vital “because it provides social workers and other health professionals with opportunities to identify pregnant women who are at risk of premature or low-weight births, and to deliver the medical, nutritional, educational, or psychosocial interventions that can promote positive pregnancy outcomes” (Perloff and Jeffee, 1999, p. 117). Early prenatal care is especially significant because of the developing fetus’s vulnerability. It is important not to assume that all women’s knowledge about prenatal care and easy access to such care is equal.
Barriers to obtaining prenatal care may include a number of factors. Women may be struggling with numerous other life issues (e.g., poverty, stress, and demands on their time for other things). Clinics and services may not be readily available and easy for them to reach. Pregnant women may experience difficulties in getting transportation for services or be struggling with other work and child-care demands. They may distrust the health-care system generally. They may have had previous bad experiences with respect to other health-care issues. They may have faced long waiting periods, crowded conditions, and inconvenient hours while trying to get services (Sable & Kelly, 2008).
There are several implications for social work practice. First, workers can help women navigate a complex health-care system, making certain they have ready access to available insurance and Medicaid payments. Second, practitioners can advocate with clinics to improve their internal environments. Providing child care, magazines, comfortable furniture, and refreshments can significantly improve the clinic experience. Third, workers can assist pregnant women “in gaining access to clinic resources (for example, appointments, laboratory tests, and educational seminars) through regular, ongoing contact with clients” (Cook, Selig, Wedge, & Baube, 1999, p. 136). Fourth, practitioners can “develop innovative service delivery models,” including screening women during their initial visit to identify those at greatest risk, mailing or calling reminders of clinic appointments, and participating in community outreach (p. 136). Outreach might entail conducting door-to-door case-finding of pregnant women to expedite early initiation of prenatal care. This could involve sharing information about risks posed without care, benefits of care, and the availability of services.
2-1gProblem Pregnancies
In addition to factors that can affect virtually any pregnancy, other problems can develop under certain circumstances. These problems include ectopic pregnancies, toxemia, and Rh incompatibility. Spontaneous abortions also happen periodically.
Ectopic Pregnancy
When a fertilized egg begins to develop somewhere other than in the uterus, it is called an ectopic pregnancy or tubal pregnancy. In most cases, the egg becomes implanted in the fallopian tube. Much more rarely, the egg is implanted outside the uterus somewhere in the abdomen.
Ectopic pregnancies most often occur because of a blockage in the fallopian tube. The current rate of ectopic pregnancy has increased dramatically from what it was 30 years ago (Hyde & DeLamater, 2014). This may be attributed partially to increasing rates of STIs that result in scar tissue (Hyde & DeLamater, 2017). Others have hypothesized that this increase in ectopic pregnancies may be due to the increased use of fertility drugs and escalating external stresses in the environment (Kelly, 2008).
Ectopic pregnancies in the fallopian tubes “may spontaneously abort and be released into the abdominal cavity, or the embryo and placenta may continue to expand, stretching the tube until it ruptures” (Hyde & DeLamater, 2017, p. 140). In the latter case, surgical removal is necessary to save the mother’s life.
Toxemia
Toxemia (also called preeclampsia) is an abnormal condition involving a form of blood poisoning. Carroll (2013b) explains:
In the last 2 to 3 months of pregnancy, 6% to 7% of women experience toxemia … or preeclampsia. Symptoms include rapid weight gain, fluid retention, an increase in blood pressure [hypertension], and protein in the urine. If toxemia is allowed to progress, it can result in eclampsia, which involves convulsions, coma, and in approximately 15% of cases, death…. Overall, [African American] … women are at higher risk for eclampsia than White or Hispanic women … (p. 319; emphasis in original)
Concept Summary
Problem Pregnancies
Ectopic pregnancy: The circumstance when a fertilized egg becomes implanted and begins to develop somewhere other than the uterus (usually in a fallopian tube).
Toxemia: A pregnant woman’s abnormal condition involving a form of blood poisoning that results in rapid weight gain, fluid retention, hypertension, and protein in the urine.
Rh incompatibility: The condition when a mother and fetus have opposite Rh factors (positive versus negative), resulting in the mother’s blood forming antibodies against the fetus’s incompatible blood.
Spontaneous abortion: The termination of a pregnancy due to natural causes before the fetus is capable of surviving on its own.
Rh Incompatibility
People’s red blood cells differ in their surface structures and can be classified in different ways (Santrock, 2016). One way of distinguishing blood type involves categorizing it as either A, B, O, or AB. Another way to differentiate blood cells involves the Rh factor, which is positive if the red blood cells carry the marker or negative if they don’t (Santrock, 2016). If the mother has Rh-negative blood and the father has Rh-positive blood, the fetus may also have Rh-positive blood. This results in Rh incompatibility between the mother’s and fetus’s blood, and the mother’s body forms antibodies in defense against the fetus’s incompatible blood. Problem pregnancies and a range of defects in the fetus may result. Problems are less likely to occur in the first pregnancy than in later ones, because antibodies have not yet had the chance to form. The consequence to an affected fetus can be intellectual disability, anemia, or death.
Fortunately, Rh incompatibility can be dealt with successfully. The mother is injected with a serum, RhoGAM, that prevents the development of future Rh-negative sensitivity. This must be administered within 72 hours after the first child’s birth or after a first abortion. In those cases where Rh sensitivity already exists, the newborn infant or even the fetus within the uterus can be given a blood transfusion.
Spontaneous Abortion
A spontaneous abortion or miscarriage is the termination of a pregnancy due to natural causes before the fetus is capable of surviving on its own. About 20 to 25 percent of all diagnosed pregnancies result in a spontaneous abortion; however, about 50 percent of non-diagnosed pregnancies are terminated by a spontaneous abortion (Hyde & DeLamater, 2017). Thus, a woman may not even be aware of the pregnancy when the miscarriage occurs. Sometimes it is perceived as an extremely heavy menstrual period. The vast majority of miscarriages occur within the first trimester, with only a small minority occurring during the second or third trimester.
Most frequently, spontaneous abortions occur as a result of a defective fetus or some physical problem of the expectant mother. The body for some reason knows that the fetus is defective or that conditions are not right, and expels the fetus. Maternal problems may include a uterus that is “too small, too weak, or abnormally shaped, … maternal stress, nutritional deficiencies, excessive vitamin A, drug exposure, or pelvic infection” (Carroll, 2013b, p. 318). Some evidence indicates that faulty sperm may also be to blame (Carrell et al., 2003).
2-1hThe Birth Process
The birth process involves three stages: early labor and active labor, the birth of the baby, and delivery of the placenta.
There are three phases of the first stage of labor: early labor, active labor, and the transition phase. Early labor is the longest phase, lasting from 8 to 12 hours (American Pregnancy Association, 2015). Contractions may come every 5–30 minutes, lasting about 30–45 seconds each time (American Pregnancy Association, 2015). As the woman moves through early labor, contractions will increase in frequency and duration. During early labor, the cervix will begin to dilate and contractions start. The woman may experience a bloody mucus discharge (the mucus plug that has been sealing the opening of the uterus is discharged) and lower back pain that will not go away (back labor); and her “water” (amniotic sac) may break (American Pregnancy Association, 2015).
For women who have health complications, such as hypertension or preeclampsia, a baby whose health may be in danger (lack of oxygen), or whose amniotic sac has ruptured but whose labor has not started, labor may be induced. Labor may be induced by starting medications, such as oxytocin and prostaglandin; by artificially rupturing the amniotic sac for those who have not experienced this yet; or by nipple stimulation to increase oxytocin production, which may trigger labor (American Pregnancy Association, 2015). More and more women are choosing to induce labor as a means of “scheduling” their pregnancies; however, doctors encourage women to keep the baby in the uterus as long as medically possible.
In addition, some women experience Braxton Hicks contractions during early labor, referred to as “false labor.” This occurs when the uterus tightens for a period of 30 seconds to 2 minutes. Unlike true labor, Braxton Hicks contractions do not grow longer, stronger, or closer together. It is important for a woman to talk to her doctor about her contractions to verify the type of contractions she is experiencing.
The second phase of early labor, active labor, lasts from 3–5 hours, during which time contractions feel stronger and last longer. It is important that the woman head to the hospital or contact the midwife during this process if she has not done so already.
Local anesthesia or an epidural (spinal anesthesia) may also be given to aid in reducing any pain during the labor process. Typically, women make a plan about having a baby naturally (without medications) or with anesthesia prior to going into labor; however, it is not uncommon for a woman to change her mind about the use or non-use of an anesthesia once labor has begun. During the final phase, the transition, the cervix will dilate to 8–10 cm. This tends to be the hardest phase, but lasts the shortest amount of time (from 30 minutes to 2 hours). Contractions are long, strong, and intense (occurring every 30 seconds to 2 minutes and lasting about 60–90 seconds) (American Pregnancy Association, 2015). In addition, the woman might experience nausea, hot flashes, or chills, and have a strong urge to push. During the second stage of transition, the birth of the baby occurs. The second stage can last from 20 minutes to 2 hours (American Pregnancy Association, 2015). The woman will be encouraged to push between contractions to help the baby move through the birth canal. The cervix is fully dilated, allowing the baby to move through the vagina. The baby’s head will eventually appear, called “crowning,” at which time the woman is told not to push any longer.
After the baby completely emerges, the umbilical cord, which still attaches the baby to its mother, is clamped and severed about three inches from the baby’s body. Because there are no nerve endings in the cord, this does not hurt. The small section of cord remaining on the infant gradually dries up and simply falls off.
At times, an episiotomy (making an incision in the perineum, away from the vagina) might be needed to help deliver the baby. This may occur when the baby’s head is too large for the vaginal opening, the baby is in distress, the perineum has not stretched enough, the baby is in a breech position, or the mother is unable to control her pushing (American Pregnancy Association, 2015). It is important to note that episiotomy rates are on the decline (American Congress of Obstetricians and Gynecologists, 2016). The American Congress of Obstetricians and Gynecologists recommends that physicians avoid performing routine episiotomies, using them only when needed for safety reasons (American Congress of Obstetricians and Gynecologists, 2016).
The last stage of labor, the afterbirth, involves the body contracting in order to remove the placenta from the uterine wall. This can take from 5 to 30 minutes (American Pregnancy Association, 2015).
Birth Positions
The majority of babies are born with their heads emerging first. Referred to as a vertex presentation, this is considered the normal birth position and most often requires no assistance with instruments. Figure 2.1 depicts various birth positions.
The birth process is an amazing experience.
Blend Images – ERproductions Ltd/Brand X Pictures/Getty Images
Figure 2.1Forms of Birth Presentation
In 1 in 25 deliveries, babies are born in a breech presentation (Santrock, 2016, p. 101). Here, the buttocks and feet appear first and the head last as the baby is born. This type of birth may merit more careful attention. Often a cesarean section is performed (Santrock, 2016). A cesarean section, or C-section, is a surgical procedure in which the baby is removed by making an incision in the abdomen through the uterus. Cesarean sections account for over 32 percent of all births in the United States (CDC, 2015).
Note that more cesarean sections are carried out in the United States than in any other nation (Santrock, 2013). Cesarean sections are necessary when the baby is in a difficult prenatal position, when the baby’s head is too large to maneuver out of the uterus and vagina, when fetal distress is detected, or when the labor has been extremely long and exhausting. Today it is usually safe with only minimal risks to the mother or infant. The mother’s recovery, however, will be longer because the incisions must heal.
A common recommendation following a cesarean delivery is that all future deliveries be done via a cesarean delivery. Despite this, many women whose first child was born through a cesarean birth want to explore a VBAC (vaginal birth after cesarean). Physicians are concerned about risks associated with VBAC procedures, but due to recent studies showing risks being low, it has been determined that a trial of labor can be attempted for most women (Papalia & Martorell, 2015).
Finally, about 1 percent of babies are born with a transverse presentation (Dacey, Travers, & Fiore, 2009). Here the baby lies crossways in the uterus. During birth, a hand or arm usually emerges first in the vagina. As such positions also merit special attention, a cesarean section is typically performed (Santrock, 2016).
In the United States, 98.8 percent of all births occur in hospital settings, and a doctor is usually present (Martin et al., 2012). However, it’s quite a different scene throughout much of the world, where home births and midwifery (the practice of having a person who is not a physician assist a mother in childbirth) are much more common. Although midwives are present for only 8.1 percent of births in the United States (American College of Nurse-Midwives, 2012), this reflects a significant increase from the less than 1 percent evident in 1975 (Martin et al., 2005).
Families also have the option of hiring a doula. A doula is a hired, trained professional who provides emotional and physical support to a woman and her partner during her entire pregnancy, from pregnancy to the postpartum period. A doula’s main role is to provide support during the labor and delivery; however, it is important to note that a doula is not a medical professional. Research has shown that support from a doula might be associated with decreased use of pain medication, decreased length of labor, and a decrease in negative childbirth experiences during the labor process (MFMER, 2016).
Natural Childbirth
In natural childbirth, the emphasis is on education for the parents, especially the mother. The intent is to maximize her understanding of the process and to minimize her fear of the unknown. Natural childbirth also emphasizes relaxation techniques. Mothers are encouraged to tune in to their normal body processes and learn to consciously relax when under stress. They are taught to breathe correctly and to facilitate the birth process by bearing down in an appropriate manner. The Lamaze method is currently popular in the United States, although other methods are also available. Most “emphasize education, relaxation and breathing exercises, and support” in addition to the partner’s role as a labor coach (Santrock, 2016, p. 107).
Many women prefer natural childbirth because it allows them to experience and enjoy the birth to the greatest extent possible. When done correctly, pain is minimized. Anesthetics are usually avoided so that maximum feeling can be attained. It allows the mother to remain conscious throughout the birth process.
Newborn Assessment
Birth is a traumatic process that is experienced more easily by some newborns, often referred to as neonates, and with more difficulty by others. Evaluation scales have been developed to assess an infant’s condition at birth. The sooner any problems can be attended to, the greater the chance of having the infant be normal and healthy. Two such scales are the Apgar and the Brazelton.
In 1953, Virginia Apgar developed a scale, commonly known as the Apgar scale, that assesses the following five variables (note the acronym):
1. Appearance: Skin color (ranging from bluish-gray to good color everywhere).
2. Pulse: Heart rate (ranging from no heart rate to at least 100 beats per minute).
3. Grimace: Reflex response (ranging from no response while the airways are being suctioned to active grimacing, pulling away, and coughing).
4. Activity: Muscle tone (ranging from limpness to active motion).
5. Respiration: Breathing (ranging from not breathing to normal breathing and strong crying) (Apgar, 1958; Berk, 2013; Steinberg et al., 2011a).
Each of these five variables is given a score of 0 to 2. Evaluation of these signs usually occurs twice—at one minute and at five minutes after birth. A maximum total score of 10 is possible. Scores of 7 through 10 indicate a normal, healthy infant. Scores of 4 through 6 suggest that some caution be taken and that the infant be carefully observed. Scores of 4 or below warn that problems are apparent. In these cases, the infant needs immediate emergency care.
A second scale used to assess the health of a newborn infant is the Brazelton (1973) Neonatal Behavioral Assessment Scale. Whereas the Apgar scale addresses the gross or basic condition of an infant immediately after birth, the Brazelton assesses more extensively the functioning of the central nervous system and behavioral responses of a newborn. Usually administered 24 to 36 hours after birth, the scale focuses on finer distinctions of behavior. It includes a range of 28 behavioral items and 18 reflex items that evaluate such dimensions as motor system control, activity level, sucking reflex, responsiveness while awake or sleeping, and attentiveness to the external environment (Brazelton Institute, 2005). Extremely low scores can indicate brain damage or a brain condition that, given time, may eventually heal (Santrock, 2013).
Birth Defects
Birth defects refer to any kind of disfigurement or abnormality present at birth. Birth defects are much more likely to characterize fetuses that are miscarried. It should be noted that the term “birth defects” carries negative undertones, and that the term does not reflect the many abilities and talents of those affected by these problems. A consensus has not been reached as to a more appropriate term. Miscarriage provides a means for the body to prevent seriously impaired or abnormal births. The specific types of birth defects are probably infinite; however, some tend to occur with greater frequency.
Down syndrome is a disorder involving an extra chromosome that results in various degrees of intellectual disability. Accompanying physical characteristics include a broad, short skull; widely spaced eyes with an extra fold of skin over the eyelids; a round, flattened face; a flattened nose; a protruding tongue; shortened limbs; and defective heart, eyes, and ears. We’ve already noted that a woman’s chances of bearing a child with Down syndrome increase significantly with her age.
Spina bifida is a condition in which the spinal column has not fused shut and consequently some nerves remain exposed. Surgery immediately after birth closes the spinal column. Muscle weakness or paralysis and difficulties with bladder and bowel control often accompany tins condition. Frequently occurring along with spina bifida is hydrocephalus, in which an abnormal amount of spinal fluid accumulates in the skull, possibly resulting in skull enlargement and brain atrophy. Spina bifida has a prevalence rate of 3.49 per 10,000 births (Centers for Disease Control [CDC], 2011).
Low-Birth-Weight and Preterm Infants
Low birth weight and preterm status (prematurity) pose grave problems for newborns. Low birth weight is defined as 5 pounds 8 ounces or less; “about 1 in every 12 babies in the United States is born with low birth weight” (March of Dimes, 2014). Primary causes for low birth weight are premature birth and fetal growth restriction (i.e., being small for gestational age due to any of a number of reasons); other maternal factors increasing risk for low birth weight include chronic health conditions (such as those involving high blood pressure, diabetes, or lung and kidney problems), some infections (especially those involving the uterus), troubles with the placenta (resulting in inadequate nutrients provided to the fetus), inadequate weight gain during pregnancy, and the pregnant mother’s behavior and experience (e.g., smoking, drinking, poor nutrition, chronic maternal health problems, and lack of access to adequate resources) (March of Dimes, 2014).
Preterm or premature babies, born before the 37th week of gestation, often experience low birth weight.
A full-term pregnancy is considered to last between 37 and 42 weeks, with most babies being born at about 40 weeks; about 1 in 10 of all babies born in the United States are preterm (CDC, 2015). Premature infants tend to weigh less because they haven’t had the necessary time to develop. Risk factors for premature birth include having born a prior premature baby, being part of a multiple birth scenario, and uterine or cervical abnormalities (CDC, 2013d). Other risk factors resemble those involved in infants having a low birth weight (CDC, 2015).
Both low birth weight and preterm status place infants at higher risk for a range of problems (CDC, 2013d; March of Dimes, 2014). However, note that most low-birth-weight babies eventually function normally (Santrock, 2013; Wilson- Costello et al., 2007; Xiong et al., 2007). The earlier infants are born and the lower their birth weight, the greater their potential for developmental delays and long-term disabilities (CDC, 2015; Santrock, 2016).
Due to modern technology and care, low-birth-weight babies are much more likely to survive than they were in the past. Yet, early on, they are also more likely to experience problems involving breathing, bleeding, heart problems, intestinal difficulties, and potential loss of vision (March of Dimes, 2014). There is some indication that by school age, low-birth-weight children are more likely to experience learning and attention difficulties or breathing problems such as asthma (Anderson et al., 2011; Berk, 2013; Santo, Portuguez, & Nunes, 2009; Santrock, 2016). Increasing evidence indicates that low-birth-weight infants have greater difficulties socializing as adults (Berk, 2013; Moster, Lie, & Markestad, 2008). Be aware, however, that it is difficult to distinguish the direct effects of low birth weight from the effects of other variables such as an impoverished or abusive environment. Highlight 2.2 addresses the circumstances of low-birth-weight infants internationally.
Highlight 2.2
An International Perspective on Low-Birth-Weight Infants
Santrock (2013) reflects on the circumstances of low-birth-weight infants in various countries around the world:
The incidence of low birth weight varies considerably from country to country. In some countries, such as India and Sudan, where poverty is rampant and the health and nutrition of mothers are poor, the percentage of low birth weight babies reaches as high as 31 percent … In the United States, there has been an increase in low birth weight infants in the last two decades. The U.S. low birth weight rate of 8.2 percent in 2007 is considerably higher than that of many other developed countries (Hamilton et al., 2009). For example, only 4 percent of infants born in Sweden, Finland, Norway, and Korea are low birth weight, and only 5 percent of those born in New Zealand, Australia, and France are low birth weight.
The causes of low birth weight also vary (Mortensen et al., 2009). In the developing world low birth weight stems mainly from the mother’s poor health and nutrition (Christian, 2009). For example, diarrhea and malaria, which are common in developing countries, can impair fetal growth if the mother becomes affected while she is pregnant. In developed countries, cigarette smoking dining pregnancy is the leading cause of low birth weight (Fertig, 2010). In both developed and developing countries, adolescents who give birth when their bodies are not fully matured are at risk of having low birth weight babies (Malamitsi-Puchner & Boutsikou, 2006). In the United States, the increase in the number of low birth weight infants is due to such factors as the use of drugs, poor nutrition, multiple births, reproductive technologies, and improved technology and prenatal care, resulting in a higher survival rate of high-risk babies (Chen et al., 2007). Nonetheless, poverty still is a major factor in preterm birth in the United States… (p. 121)
Social work roles that are used to help pregnant women bear healthy infants might include that of a broker to help women get the resources they need. These resources include access to good nutrition and prenatal care. If such resources are unavailable, especially to poor women, social workers might need to advocate on the women’s behalf. Funding sources and services might need to be developed.
Treatment for low-birth-weight babies includes immediate medical attention to meet their special needs and provision of educational and counseling support. Group counseling for parents and weekly home visits to teach parents how to care for their children, play with them, and provide stimulation to develop cognitive, verbal, and social skills also appear to be helpful. 2-2 Early Functioning of the Neonate
The average full-term newborn weighs about pounds and is approximately 20 inches long (most weigh from to 10 pounds, and measure from 18 to 22 inches long). Girls tend to weigh a bit less and to be shorter than boys. Many parents may be surprised at the sight of their newborn, who does not resemble the cute, pudgy, smiling, gurgling baby typically shown in television commercials. Rather, the baby is probably tiny and wrinkled with a disproportionate body and squinting eyes. Newborns need time to adjust to the shock of being born. Meanwhile, they continue to achieve various milestones in development. They gain more and more control over their muscles and are increasingly better able to think and respond.
First, newborn babies generally spend much time sleeping, although the time spent decreases as the baby grows older. Second, babies tend to respond in very generalized ways. They cannot make clear distinctions among various types of stimuli, nor can they control their reactions in a precise manner. Any type of stimulation tends to produce a generalized flurry of movement throughout the entire body.
Several reflexes that characterize newborns should be present in normal neonates. First, there is the sucking reflex. This obviously facilitates babies’ ability to take in food. Related to this is a second basic reflex, rooting. Normal babies will automatically move their heads and begin a sucking motion with their mouths whenever touched even lightly on the lips or cheeks beside the lips. The rooting reflex refers to this automatic movement toward a stimulus.
A third important reflex is the Moro reflex, or startle reflex. Whenever infants hear a sudden loud noise, they automatically react by extending their arms and legs, spreading their fingers, and throwing their heads back. The purpose of this reflex is unknown, and it seems to disappear after a few months of life.
Five additional reflexes are the stepping reflex, the grasping reflex, the Babinski reflex, the swimming reflex, and the tonic neck reflex. The stepping reflex involves infants’ natural tendency to lift a leg when held in an upright position with feet barely touching a surface. In a way, it resembles the beginning motions involved in walking. The grasping reflex refers to a newborn’s tendency to grasp and hold objects such as sticks or fingers when placed in the palms of their hands. The Babinski reflex involves the stretching, fanning movement of the toes whenever the infant is stroked on the bottom of the foot. The swimming reflex involves infants making swimming motions when they’re placed face down in water. Finally, the tonic neck reflex is the infant’s turning of the head to one side when laid down on its back, the extension of the arm and leg on the side it’s facing, and the flexing of the opposite limbs. Sometimes, this is referred to as the “fencer” pose as it resembles just that.
2-3 Explain Typical Developmental Milestones for Infants and Children
LO 2
As infants grow and develop, their growth follows certain patterns and principles. At each stage of development, people are physically and mentally capable of performing certain types of tasks. Human development is the continuous process of growth and change, involving physical, mental, emotional, and social characteristics, that occurs over a lifespan. Human development is predictable in that the same basic changes occur sequentially for everyone. However, enough variation exists to produce individuals with unique attributes and experiences.
Four major concepts are involved in understanding the process of human development:
· (1)
growth as a continuous, orderly process,
· (2)
specific characteristics of different age levels,
· (3)
the importance of individual differences, and
· (4)
the effects of both heredity and the social environment.
2-3aGrowth as a Continuous, Orderly Process
People progress through a continuous, orderly sequence of growth and change as they pass from one age level to another. This has various implications. For one thing, growth is continuous and progressive. People are continually changing as they get older. For another thing, the process is relatively predictable and follows a distinct order. For example, an infant must learn how to stand up before learning how to run. All people tend to follow the same order in terms of their development. For instance, all babies must learn how to formulate verbal sounds before learning how to speak in complete sentences.
Several subprinciples relate to the idea that development is an orderly process. One is that growth always follows a pattern from simpler and more basic to more involved and complex. Simple tasks must be mastered before more complicated ones can be undertaken.
Another subprinciple is that aspects of development progress from being more general to being more specific. Things become increasingly more differentiated. For example, infants initially begin to distinguish between human faces and other objects such as balloons. This is a general developmental response. Later they begin to recognize not only the human face, but also the specific faces of their parents. Eventually, as they grow older they can recognize the faces of Uncle Horace, Mr. Schmidt the grocer, and then-best friend Joey. Their recognition ability has progressed from being very basic to being very specific.
Two other subprinciples involve cephalocaudal development and proximodistal development. Cephalocaudal development refers to development from the head to the toes. Infants begin to learn how to use the parts of the upper body such as the head and arms before their legs. Proximodistal development refers to the tendency to develop aspects of the body trunk first and then later master manipulation of the body extremities (e.g., first the arms and then the hands).
2-3bSpecific Characteristics of Different Age Levels
A second basic developmental principle is that each age period tends to have specific characteristics. During each stage of life, from infancy throughout adulthood, “typical” people are generally capable of performing certain tasks. Capabilities tend to be similar for all people within any particular age category. Developmental guidelines provide a very general means for determining whether an individual is progressing and developing typically.
2-3cIndividual Differences
The third basic principle of development emphasizes that people have individual differences. Although people tend to develop certain capacities in a specified order, the ages at which particular individuals master certain skills may show a wide variation. Some people may progress through certain stages faster. Others will take more time to master the same physical and mental skills. Variation may occur in the same individual from one stage to the next. The specific developmental tasks and skills that characterize each particular age level may be considered an average of what is usually accomplished during that level. Any average may reflect a wide variation. People may still be “typical” if they fall at one of the extremes that make up the average.
2-3dThe Nature-Nurture Controversy
A fourth principle involved in understanding human development is that both heredity and the surrounding environment affect development. Individual differences, to some extent, may be influenced by environmental factors. People are endowed with some innate ability and potential. In addition, the impinging environment acts to shape, enhance, or limit that ability.
For example, take a baby who is born with the potential to grow and develop into a typical adult, both physically and intellectually. Nature provides the individual baby with some prospective potential. However, if the baby happens to be living in a developing country during a famine, the environment or nurture may have drastic effects on the baby’s development. Serious lack of nourishment limits the baby’s eventual physical and mental potential.
Given the complicated composition of human beings, the exact relationship between hereditary potential and environmental effects is unclear. It is impossible to quantify how much the environment affects development compared to how much development is affected by heredity. This is often referred to as the nature-nurture controversy. Theorists assume stands at both extremes. Some state that nature’s heredity is the most important. Others hypothesize that the environment imposes the crucial influence.
You might consider that each individual has a potential that is to some extent determined by inheritance. However, this potential is maximized or minimized by what happens to people in their particular environments.
Former president Ronald Reagan maintained only a C average in college. Yet he was able to attain the most powerful position in the United States. It is difficult to determine how much of his success was due to innate ability and how much to situations and opportunities he encountered in his environment.
Our approach is that a person develops as the result of a multitude of factors including those that are inherited and those that are environmental.
2-3eRelevance to Social Work
Knowledge of human development and developmental milestones can be directly applied to social work practice. Assessment is a basic fact of intervention throughout the lifespan. In order to assess human needs and human behavior accurately, the social worker must know what is considered normal or appropriate. He or she must decide when intervention is necessary and when it is not. Comparing observed behavior with what is considered normal behavior provides a guideline for these decisions.
This book will address issues in human development throughout the lifespan. A basic understanding of every age level is important for generalist practice. However, an understanding of the normal developmental milestones for young children is especially critical. Early assessment of potential developmental lags or problems allows for maximum alleviation or prevention of future difficulties. For example, early diagnosis of a speech problem will alert parents and teachers to provide special remedial help for a child. The child will then have a better chance to make progress and possibly even catch up with peers.
2-4 Profiles of Typical Development for Children Ages 4 Months to 11 Years
Children progress through an organized sequence of behavior patterns as they mature. Research has established indicators of normality such as when children typically say their first word, run adeptly, or throw a ball overhand. These milestones reflect only an average indication of typical accomplishments. Children need not follow this profile to the letter. Typical human development provides for much individual variation. Parents do not need to be concerned if their child cannot yet stand alone at 13 months instead of the average 12 months. However, serious lags in development or those that continue to increase in severity should be attended to. This list can act as a screening guide to determine whether a child might need more extensive evaluation.
Each age profile is divided into five assessment categories. They include motor or physical behavior, play activities, adaptive behavior that involves taking care of self, social responses, and language development. All five topics are addressed together at each developmental age level in order to provide a more complete assessment profile.
Occasionally, case vignettes are presented that describe children of various ages. Evaluate to what extent each of these children fits the developmental profile.
2-4aAge 4 Months
Motor: Four-month-old infants typically can balance their heads at a 90-degree angle. They can also lift their heads and chests when placed on their stomachs in a prone position. They begin to discover themselves. They frequently watch their hands, keep their fingers busy, and place objects in their mouths.
Adaptive: Infants are able to recognize their bottles. The sight of a bottle often stimulates bodily activity. Sometimes teething begins tins early, although the average age is closer to 6 or 7 months.
Social: These infants are able to recognize their mothers and other familiar faces. They imitate smiles and often respond to familiar people by reaching, smiling, laughing, or squirming.
Language: The 4-month-old will turn his or her head when a sound is heard. Verbalizations include gurgling, babbling, and cooing.
2-4bAge 8 Months
Motor: Eight-month-old babies are able to sit alone without being supported. They usually are able to assist themselves into a standing position by pulling themselves up on a chair or crib. They can reach for an object and pick it up with all their fingers and a thumb. Crawling efforts have begun. These babies can usually begin creeping on all fours, displaying greater strength in one leg than the other.
Children achieve their developmental milestones step by step.
Hideaki Shinohara/Moment/Getty Images
Play: The baby is capable of banging two toys together. Many can also pass an object from one hand to the other. These babies can imitate arm movements such as splashing in a tub, shaking a rattle, or crumpling paper.
Adaptive: Babies of this age can feed themselves pieces of toast or crackers. They will be able to munch instead of being limited to sucking.
Social: Babies of this age can begin imitating facial expressions and gestures. They can play pat-a-cake and peekaboo, and wave bye-bye.
Language: Babbling becomes frequent and complex. Most babies will be able to attempt copying the verbal sounds they hear. Many can say a few words or sounds such as mama or dada. However, they don’t yet understand the meaning of words. 2-4cAge 1 Year
Motor: By age 1 year, most babies can crawl well, which makes them highly mobile. Although they usually require support to walk, they can stand alone without holding onto anything. They eagerly reach out into their environments and explore things. They can open drawers, undo latches, and pull on electrical cords.
Play: One-year-olds like to examine toys and objects both visually and by touching them. They typically like to handle objects by feeling them, poking them, and turning them around in their hands. Objects are frequently dropped and picked up again one time after another. Babies of this age like to put objects in and take them out of containers. Favorite toys include large balls, bottles, bright dangling toys, clothespins, and large blocks.
Adaptive: Because of their mobility, 1-year-olds need careful supervision. Because of their interest in exploration, falling down stairs, sticking forks in electric sockets, and eating dead insects are constant possibilities. Parents need to scrutinize their homes and make them as safe as possible.
Babies are able to drink from a cup. They can also run their spoon across their plate and place the spoon in their mouths. They can feed themselves with their fingers. They begin to cooperate while being dressed by holding still or by extending an arm or a leg to facilitate putting the clothes on. Regularity of both bowel and bladder control begins.
Social: One-year-olds are becoming more aware of the reactions of those around them. They often vary their behavior in response to these reactions. They enjoy having an audience. For example, they tend to repeat behaviors that are laughed at. They also seek attention by squealing or making noises.
Language: By 1 year, babies begin to pay careful attention to the sounds they hear. They can understand simple commands. For instance, on request they often can hand you the appropriate toy. They begin to express choices about the type of food they will accept or about whether it is time to go to bed. They imitate sounds more frequently and can meaningfully use a few other words in addition to mama and dada.
Case Vignette A: To what extent does this child fit the developmental profile?
Wyanet, age 1 year, is able to balance her head at a 90-degree angle. She can also lift her head when placed on her stomach in a prone position. She is not yet able to sit alone. She can recognize her bottle and her mother. Verbalizations include gurgling, babbling, and cooing.
2-4dAge 18 Months
Motor: By 18 months, a baby can walk. Although these children are beginning to run, their movements are still awkward and result in frequent falls. Walking up stairs can be accomplished by a caregiver holding the baby’s hand. These babies can often descend stairs by themselves but only by crawling down backward or by sliding down by sitting first on one step and then another. They are also able to push large objects and pull toys.
Play: Babies of this age like to scribble with crayons and build with blocks. However, it is difficult for them to place even three or four blocks on top of each other. These children like to move toys and other objects from one place to another. Dolls or stuffed animals frequently are carried about as regular companions. These toys are also often shown affection such as hugging. By 18 months, babies begin to imitate some of the simple things that adults do such as turning pages of a book.
Adaptive: Ability to feed themselves is much improved by age 18 months. These babies can hold their own glasses to drink from, usually using both hands. They are able to use a spoon sufficiently to feed themselves.
By this age, children can cooperate in dressing. They can unfasten zippers by themselves and remove their own socks or hats. Some regularity has also been established in toilet training. These babies often can indicate to their parents when they are wet and sometimes wake up at night in order to be changed.
Social: Children function at the solitary level of play. It is normal for them to be aware of other children and even enjoy having them around; however, they don’t play with other children.
Language: Children’s vocabularies consist of more than 3 but less than 50 words. These words usually refer to people, objects, or activities with which they are familiar. They frequently chatter using meaningless sounds as if they were really talking like adults. They can understand language to some extent. For instance, children will often be able to respond to directives or questions such as “Give Mommy a kiss,” or “Would you like a cookie?”
Case Vignette B: To what extent does this child fit the developmental profile?
Luis, age 18 months, can crawl well but is unable to stand by himself. He likes to scribble with crayons and build with blocks. However, it is difficult for him to place even three or four blocks on top of each other. He can say a few sounds, including mama and dada, but he cannot yet understand the meaning of words.
2-4eAge 2 Years
Motor: By age 2, children can walk and run quite well. They also can often master balancing briefly on one foot and throwing a ball in an overhead manner. They can use the stairs themselves by taking one step at a time and by placing both feet on each step. They are also capable of turning pages of a book and stringing large beads.
Play: Two-year-olds are very interested in exploring their world. They like to play with small objects such as toy animals and can stack up to six or seven blocks. They like to play with and push large objects such as wagons and walkers. They also enjoy exploring the texture and form of materials such as sand, water, and clay. Adults’ daily activities such as cooking, carpentry, or cleaning are frequently imitated. Two-year-olds also enjoy looking at books and can name common pictures.
Adaptive: Two-year-olds begin to be capable of listening to and following directions. They can assist in dressing rather than merely cooperating. For example, they may at least try to button their clothes, although they are unlikely to be successful. They attempt washing their hands. A small glass can be held and used with one hand.
They use spoons to feed themselves fairly well. Two-year-olds have usually attained daytime bowel and bladder control with only occasional accidents. Nighttime control is improving but still not complete.
Social: These children play alongside each other, but not with each other in a cooperative fashion. They are becoming more and more aware of the feelings and reactions of adults. They begin to seek adult approval for correct behavior. They also begin to show their emotions in the forms of affection, guilt, or pity. They tend to have mastered the concept of saying no, and use it frequently.
Language: Two-year-olds can usually put two or three words together to express an idea. For instance, they might say, “Daddy gone,” or “Want milk.” Their vocabulary usually includes more than 50 words. Over the next few months, new vocabulary will steadily increase into hundreds of words. They can identify common facial features such as eyes, ears, and nose. Simple directions and requests are usually understood. Although 2-year-olds cannot yet carry on conversations with other people, they frequently talk to themselves or to their toys. It’s common to hear them ask, “What’s this?” in their eagerness to learn the names of things. They also like to listen to simple stories, especially those with which they are very familiar.
Case Vignette C: To what extent does this child fit the developmental profile?
Kenji, age 2 years, can walk well but still runs with an awkward gait. He likes to play with and push large objects such as wagons and walkers. He also likes to play alongside other children but is not able to play with them in a cooperative fashion. His vocabulary includes about 25 words, but he is not yet very adept at putting two to three words together to express an idea.
2-4fAge 3 Years
Motor: At age 3, children can walk well and also run at a steady gait. They can stop quickly and turn corners without falling. They can go up and down stairs using alternating feet. They can begin to ride a tricycle. Three-year-olds participate in a lot of physically active activities such as swinging, climbing, and sliding.
Play: By age 3, children begin to develop their imagination. They use books creatively such as making them into fences or streets. They like to push toys such as trains or cars in make-believe activities. When given the opportunity and interesting toys and materials, they can initiate their own play activities. They also like to imitate the activities of others, especially those of adults. They can cut with scissors and can make some controlled markings with crayons.
Adaptive: Three-year-olds can actively help in dressing. They can put on simple items of clothing such as pants or a sweater, although their clothes may be on backward or inside out. They begin to try buttoning and unbuttoning their own clothes. They eat well by using a spoon and have little spilling. They also begin to use a fork. They can get their own glass of water from a faucet and pour liquid from a small pitcher. They can wash their hands and face by themselves with minor help. By age 3, children can use the toilet by themselves, although they frequently ask someone to go with them. They need only minor help with wiping. Accidents are rare, usually happening only occasionally at night.
Social: Three-year-olds tend to pay close attention to the adults around them and are eager to please. They attempt to follow directions and are responsive to approval or disapproval. They also can be reasoned with at this age. By age 3, children begin to develop their capacity to relate to and communicate with others. They show an interest in the family and in family activities. Their play is still focused on the parallel level where their interest is concentrated primarily on their own activities. However, they are beginning to notice what other children are doing. Some cooperation is initiated in the form of taking turns or verbally settling arguments.
Language: Three-year-olds can use sentences that are longer and more complex. Plurals, personal pronouns such as I, and prepositions such as above or on are used appropriately. Children are able to express their feelings and ideas fairly well. They are capable of relating a story. They listen fairly well and are very interested in longer, more complicated stories than they were at an earlier age. They also have mastered a substantial amount of information including their last name, their gender, and a few rhymes.
2-4gAge 4 Years
Motor: Four-year-olds tend to be very active physically. They enjoy running, skipping, jumping, and performing stunts. They are capable of racing up and down stairs. Their balance is very good, and they can carry a glass of liquid without spilling it.
Play: By age 4, children have become increasingly creative and imaginative. They like to construct things out of clay, sand, or blocks. They enjoy using costumes and other pretend materials. They can play cooperatively with other children. They can draw simple figures, although they are frequently inaccurate and without much detail. Four-year-olds can also cut or trace along a line fairly accurately.
Adaptive: Four-year-olds tend to be very assertive. They usually can dress themselves. They’ve mastered the use of buttons and zippers. They can put on and lace their own shoes, although they cannot yet tie them. They can wash their hands without supervision. By age 4, children demand less attention while eating with their family. They can serve themselves food and eat by themselves using both spoon and fork. They can even assist in setting the table. Four-year-olds can use the bathroom by themselves, although they still alert adults of this and sometimes need assistance in wiping. They usually can sleep through the night without having any accidents.
Social: Four-year-olds are less docile than 3-year-olds. They are less likely to conform, in addition to being less responsive to the pleasure or displeasure of adults. Four-year-olds are in the process of separating from their parents and begin to prefer the company of other children over adults. They are often social and talkative. They are very interested in the world around them and frequently ask “what,” “why,” and “how” questions.
Language: The aggressiveness manifested by 4-year-olds also appears in their language. They frequently brag and boast about themselves. Name calling is common. Their vocabulary has experienced tremendous growth; however, they have a tendency to misuse words and some difficulty with proper grammar. Four-year-olds talk a lot and like to carry on long conversations with others. Their speech is usually very understandable with only a few remnants of earlier, more infantile speech remaining. Their growing imagination also affects their speech. They like to tell stories and frequently mix facts with make-believe.
Case Vignette D: To what extent does this child fit the developmental profile?
Chaniqwa, age 4 years, is very active physically. She enjoys running, skipping, jumping, and performing stunts. She can use the bathroom by herself. She has a substantial vocabulary, although she has a tendency to misuse words and use improper grammar.
2-4hAge 5 Years
Motor: Five-year-olds are quieter and less active than 4-year-olds. Their activities tend to be more complicated and more directed toward achieving some goal. For example, they are more adept at climbing and at riding a tricycle. They can also use roller skates, jump rope, skip, and succeed at other such complex activities. Their ability to concentrate is also increased. The pictures they draw, although simple, are finally recognizable. Dominance of the left or right hand becomes well established.
Play: Games and play activities have become both more elaborate and competitive. Games include hide-and-seek, tag, and hopscotch. Team playing begins. Five-year-olds enjoy pretend games of a more elaborate nature. They like to build houses and forts with blocks and to participate in more dramatic play such as playing house or being a space invader. Singing songs, dancing, and playing DVDs are usually very enjoyable.
Adaptive: Five-year-olds can dress and undress themselves quite well. Assistance is necessary only for adjusting more complicated fasteners and tying shoes. These children can feed themselves and attend to their own toilet needs. They can even visit the neighborhood by themselves, needing help only in crossing streets.
Social: By age 5, children have usually learned to cooperate with others in activities and enjoy group activities. They acknowledge the rights of others and are better able to respond to adult supervision. They have become aware of rules and are interested in conforming to them. Five-year-olds also tend to enjoy family activities such as outings and trips.
Language: Language continues to develop and becomes more complex. Vocabulary continues to increase. Sentence structure becomes more complicated and more accurate. Five-year-olds are very interested in what words mean. They like to look at books and have people read to them. They have begun learning how to count and can recognize colors. Attempts at drawing numbers and letters are begun, although fine motor coordination is not yet well enough developed for great accuracy.
Case Vignette E: To what extent does this child fit the developmental profile?
Sheridan, age 5 years, can draw simple although recognizable pictures. Dominance of her left hand has become well established. She can readily dress and undress herself. She enjoys playing in groups of other children and can cooperate with them quite well. She has a vocabulary of about 50 words. She can use pronouns such as I and prepositions such as on and above appropriately. She can put two or three words together and use them appropriately, although she has difficulty formulating longer phrases and sentences.
2-4iAges 6 to 8 Years
Motor: Children ages 6 to 8 years are physically independent. They can run, jump, and balance well. They continue to participate in a variety of activities to help refine their coordination and motor skills. They often enjoy unusual and challenging activities, such as walking on fences, which help to develop such skills.
Children ages 6 to 8 love action play. They can run, jump, and balance well.
iStock.com/monkeybusinessimages
Play: These children participate in much active play such as kickball. They like activities such as gymnastics and enjoy trying to perform physical stunts. They also begin to develop intense interest in simple games such as marbles or tiddlywinks and collecting items. Playing with dolls is at its height. Acting out dramatizations becomes very important; these children love to pretend they are animals, horseback riders, or jet pilots.
Adaptive: Much more self-sufficient and independent, these children can dress themselves, go to bed alone, and get up by themselves during the night to go to the bathroom. They can begin to be trusted with an allowance. They are able to go to school or to friends’ homes alone. In general, they become increasingly more interested in and understanding of various social situations.
Social: In view of their increasing social skills, they consider playing skills within their peer group increasingly important. They become more and more adept at social skills. Their lives begin to focus around the school and activities with friends. They are becoming more sensitive to reactions of those around them, especially those of their parents. There is some tendency to react negatively when subjected to pressure or criticism. For instance, they may sulk.
Language: The use of language continues to become more refined and sophisticated. Good pronunciation and grammar are developed according to what they’ve been taught. They are learning how to put their feelings and thoughts into words to express themselves more clearly. They begin to understand more abstract words and forms of language. For example, they may begin to understand some puns and jokes. They also begin to develop reading, writing, and numerical skills.
2-4jAges 9 to 11 Years
Motor: Children continue to refine and develop their coordination and motor skills. They experience a gradual, steady gain in body measurements and proportion. Manual dexterity, posture, strength, and balance improve. This period of late childhood is transitional to the major changes experienced during adolescence.
Play: This period frequently becomes the finale of the games and play of childhood. If it has not already occurred, boys and girls separate into their respective same-gender groups.
Adaptive: Children become more and more aware of themselves and the world around them. They experience a gradual change from identifying primarily with adults to formulating their own self-identity. They become more independent. This is a period of both physical and mental growth. These children push themselves into experiencing new things and new activities. They learn to focus on detail and accomplish increasingly difficult intellectual and academic tasks.
Social: The focus of attention shifts from a family orientation to a peer orientation. They continue developing social competence. Friends become very important.
Language: A tremendous increase in vocabulary occurs. These children become adept at the use of words. They can answer questions with more depth of insight. They understand more abstract concepts and use words more precisely. They are also better able to understand and examine verbal and mathematical relationships.
2-4kA Concluding Note
We emphasize that individuals vary greatly in their attainment of specific developmental milestones. The developmental milestones provide a general baseline for assessment and subsequent intervention decisions. If a child is assessed as being grossly behind in terms of achieving normal developmental milestones, then immediate intervention may be needed. On the other hand, if a child is only mildly behind his or her normal developmental profile, then no more than close observation may be appropriate. In the event that the child continues to fall further behind, help can be sought and provided.
2-5 Significant Issues and Life Events
Two significant issues will be discussed that relate to the decision of whether to have children. They have been selected because they affect a great number of people and because they often pose a serious crisis for the people involved. The issues are abortion and infertility.
2-6 Examine the Abortion Controversy: Impacts of Social and Economic Forces
LO 3
Many unique circumstances are involved in any unplanned pregnancy. Individuals must evaluate for themselves the potential consequences of each alternative and assess the positive and negative consequences of each.
A basic decision involved in unplanned pregnancy is whether to have the baby. If the decision is made to have the baby, and the mother is unmarried, a subset of alternatives must then be evaluated. One option is to marry the father (or to establish some other ongoing relationship with him). A second alternative is for the mother to keep the baby and live as a single parent. In the past decade, the media have given increasing attention to fathers who seek custody. Joint custody is a viable option. Or the mother’s parents (the child’s grandparents) or other relatives could either keep the baby or assist in its care. Still another option is adoption. Each choice involves both positive and negative consequences.
Abortion is the termination of a pregnancy by removing an embryo or fetus from the uterus before it can survive on its own outside the womb. Social workers may find themselves in the position of helping their clients explore abortion as one possibility open to them. Highlight 2.3 provides a case example of how one young woman struggled with her dilemma.
Highlight 2.3
Case Example: Single and Pregnant
Roseanne was 21 years old and two months pregnant. She was a junior at a large midwestern state university, majoring in social work. Hank, the father, was a 26-year-old divorce she met in one of her classes. He already had a 4-year-old son named Ronnie.
Roseanne was filled with ambivalent feelings. She had always pictured herself as being a mother someday—but not now. She felt she loved Hank but had many reservations about how he felt in return. She’d been seeing him once or twice a week for the past few months. Hank didn’t really take her out much, and she suspected that he was also dating other women. He had even asked her to babysit for Ronnie while he went out with someone else.
That was another thing—Ronnie. She felt Ronnie hated her. He would snarl whenever she came over and make nasty, cutting remarks. Maybe he was jealous that his father was giving Roseanne attention.
The pregnancy was an accident. She simply didn’t think anything would happen. She knew better now that it was too late. Hank had never made any commitment to her. In some ways she felt he was a creep, but at least he was honest. The fact was that he just didn’t love her.
The problem was, what should she do? A college education was important to her and to her parents. Money had always been a big issue. Her parents helped her as much as they could, but they also had other children in college. Roseanne worked odd, inconvenient hours at a fast-food restaurant for a while. She also worked as a cook several nights a week at a diner.
What if she kept the baby? She was fairly certain Hank didn’t want to marry her. Even if he did, she didn’t think she’d want to be stuck with him for the rest of her life. How could she possibly manage on her own with a baby? She shared a two-bedroom apartment with three other female students. How could she take care of a baby with no money and no place to go? She felt dropping out of college would ruin her life. The idea of going on welfare instead of working in welfare was terrifying.
What about adoption? That would mean seven more months of pregnancy while she was going to college. She wondered what her friends and family would say about choosing adoption as an option. She thought about how difficult that would be—she would always wonder where her child was and how he or she was doing. She couldn’t bear the thought of pursuing this option.
Yet, the idea of an abortion scared her. She had heard so many people say that it was murder.
Roseanne made her decision, but it certainly was not an easy one. She carefully addressed and considered the religious and moral issues involved in terminating a pregnancy. She decided that she would have to face the responsibility and the guilt. In determining that having a baby at this time would be disastrous both for herself and for a new life, she decided to have an abortion.
Fourteen years have passed. Roseanne is now 35. She is no longer in social work, although she finished her degree. She does have a good job as a court reporter. This job suits her well. She’s been married to Tom for three years. Although they have their ups and downs, she is happy in her marriage. They love each other very much and enjoy their time together.
Roseanne thinks about her abortion once in a while. Although she is using no method of contraception, she has not yet gotten pregnant. Possibly she never will. Tom is 43. He has been married once before and has an adult child from that marriage. He does not feel it is a necessity for them to have children.
Roseanne is ambivalent. She is addressing the possibility of not having children and is looking at the consequences of that alternative. She puts it well by saying that sometimes she mourns the loss of her unborn child. Yet, in view of her present level of satisfaction and Tom’s hesitation about having children, she feels that her life thus far has worked out for the best.
The concept of abortion inevitably elicits strong feelings and emotions. These feelings can be very positive or negative. People who take stands against abortion often do so on moral and ethical grounds. A common theme is that each unborn child has the right to life. On the opposite pole are those who feel strongly in favor of abortion. They feel that women have the right to choice over their own bodies and lives.
The issue concerning unplanned and, in this context, unwanted pregnancy provides an excellent example of how macro-system values affect the options available to clients. In June 1992, the U.S. Supreme Court ruled that states have extensive power to restrict abortions, although they cannot outlaw all abortions. Due to this ruling, restrictions have increased significantly. From 2011 to 2013, 205 new restrictions were enacted in the United States (Center for Reproductive Rights, 2014). If abortions are illegal or unavailable to specific groups in the population, then women’s choices about what to do are much more limited.
The abortion issue illustrates how clients function within the contexts of their mezzo and macro environments. For example, perhaps a woman’s parents are unwilling to help her with a newborn, or the child’s father shuns involvement. In both these instances, some of the woman’s potential mezzo system options have already been eliminated.
The abortion issue is one of most controversial in the country. Here, opposite sides confront each other at a demonstration.
Bill Clark/CQ-Roll Call Group/Getty Images
Options are also affected by macro environments. If abortion is illegal, then social agencies are unable to provide them. Another possibility is that states can legally allow abortion only under extremely limited circumstances. For instance, it may be allowed only if the conception is the product of incest or rape, or if the pregnancy and birth seriously endanger the pregnant woman’s life.
Even if states allow abortions, the community in which a pregnant woman lives can pose serious restrictions on her options. For instance, a community renowned for having a strong and well-organized antiabortion movement may be supportive of actions (including legal actions) to curtail abortion services. Abortion clinics can be picketed, patients harassed, and clinic staff personally threatened. Such strong community feelings can force clinics to close.
EP 1
Additionally, the abortion issue provides an excellent opportunity to distinguish between personal and professional values. Each of us probably has an opinion about abortion. Some of us most likely have strong opinions either one way or the other. In practice, our personal opinions really don’t matter. However, our professional approach does. As professionals, it is our responsibility to help clients come to their own decisions. Our job is to assist clients in assessing their own feelings and values, in identifying available alternatives, and in evaluating as objectively as possible the consequences of each alternative. It is critical that social workers provide options, not advice.
The National Association of Social Workers (NASW) has established issue and policy statements on family planning and reproductive choice that include its stance on abortion. A policy is a clearly stated or implicit procedure, plan, rule, or stance concerning some issue that serves to guide decision making and behavior. The statements read as follows:
“As social workers, we support the right of individuals to decide for themselves, without duress and according to their own personal beliefs and convictions, whether they want to become parents, how many children they are willing and able to nurture, the opportune time for them to have children, and with whom they may choose to parent … To support self-determination, … reproductive health services, including abortion services, must be legally, economically, and geographically accessible to all who need them … Denying people with low income access to the full range of contraceptive methods, abortion, and sterilization services, and the educational programs that explain them, perpetuate poverty and the dependence on welfare programs and support the status quo of class stratification … NASW supports …
· [A] woman’s right to obtain an abortion, performed according to accepted medical standards and in an environment free of harassment or threat for both patients and providers.
· [R]eproductive health services, including abortion services, that are confidential, available at a reasonable cost, and covered in public and private health insurance plans on a par with other kinds of health services (contraceptive equity).
· [I]mproved access to the full range of reproductive health services, including abortion services, for groups currently underserved in the United States, including people with low income and those who rely on Medicaid to pay for their health care …” (NASW, 2012, pp. 131, 133)
Seven aspects of abortion are discussed here. First, we describe the current impact of legal and political macro systems. Second, we note the incidence of abortion and provide a profile of women who have abortions. Third, we explore reasons why women seek abortions. Fourth, we explain the abortion process itself and the types of abortion available. Fifth, we briefly examine some of the psychological effects of abortion. Sixth, we compare and assess the arguments for and against abortion. Seventh, we describe a variety of social work roles with respect to the abortion issue.
2-6aThe Impacts of Macro-System Policies on Practice and Access to Services
People’s values affect laws that, in turn, regulate policy regarding how people can make decisions and choose to act. Government and agency policies specify and regulate what services organizations can provide to women within communities. Subsequently, whether services are available or not controls the choices available to most pregnant women.
The abortion debate focuses on two opposing perspectives, antiabortion and pro-choice. Carroll (2013b) describes the antiabortion stance as the belief “that human life begins at conception, and thus an embryo, at any stage of development, is a person. [Therefore,] … aborting a fetus is murder, and … the government should make all abortions illegal” (p. 366).
Pro-choice advocates, on the other hand, focus on a woman’s right to choose whether to have an abortion. They believe that a woman has the right to control what happens to her own body, to navigate her own life, and to pursue her own current and future happiness.
