Heavy dosages of drugs given to the mother to ease the pain of birth likewise influence early postnatal adjustment. The more anesthesia given to the mother, the longer and the more difficult the adjustments of the newborn infant. A comparison of newborn infants whose mothers had received anesthesia in different amounts revealed that for infants whose mothers were heavily medicated, the disorganization of behavior immediately after birth lasted 3 to 4 days, as compared with 1 to 2 days for those whose mothers had very light medication or none at all. The effects on the infant, however, varied according to the type, amount, and timing of medication. An inhalant anesthesia, for example, had a more transient effect than premedication, such as barbiturates.
The medication likewise affected breast feeding, though no significant effect was found after the first five days of life, except that infants whose mothers had heavy medication lost more weight and took a longer time to regain it than those whose mothers had less. This difference is shown in which reveals that infants whose mothers had low medication started to regain their lost weight after 3 days, as compared with 6 days for those whose mothers were given high medication.
Intense and prolonged nervous and emotional disturbances of the mother during the last months of pregnancy cause a hyperactive state in the fetus. The effects of prenatal disturbances persist after birth and manifest themselves in various body functions as feeding difficulties, gastrointestinal dysfunction, sleep problems, hyperactivity, and general irritability. In discussing the effects of an unfavorable prenatal environment on postnatal adjustments, Sontag has pointed out that a newborn infant with such a hackground is "to all intents and purposes a neurotic infant when he is born -the result of an unsatisfactory fetal environment. In this instance, he has not had to wait until childhood for a bad home situation or other cause to make him neurotic. It was done for him before he even saw the light of day".
Some infants are unable to adjust to their postnatal environments. As a result, they die at birth or shortly afterward. While the per centages of stillbirths-deaths at birth or immediately following birth and deaths during the period of postnatal adjustment have been declining in recent years owing to in proved medical techniques of prenatal care, childbirth, and postnatal care, the death toll is still high. The most critical time is the day of birth, and the next most critical times are the second and third days after birth.
The most common causes of death at birth or immediately afterward are prematurity, congenital debility, malformation, injury at birth, pneumonia, influenza, diarrhea, and deficiency of oxygen resulting either from the excessive use of drugs to relieve the pains of childbirth or from having the umbilical cord tighten around the fetal neck during the birth process. In one study of deaths at birth or within the first few days after birth, 36 percent of the infants were born prematurely, 21.6 per cent were born in breech position, and 14.7 percent were born in a posterior position. There are more deaths among infants delivered by caesarean section than among those born spontaneously.
A number of factors influence the mortality rate during the neonatal period. Sex differences exist, with more boys dying than girls, even when they have the same birth weight. Racial differences are marked, with non whites showing a higher mortality rate than whites. In neighborhoods which are predominantly Negro, for example, the mortality rate is greater than in predominantly white neighborhoods. Mortality rates increase as the number of Negroes in the neighborhood increases. Women who experience stressful pregnancies have more difliculties in childbirth than women whose pregnancies are less emotional, and their babies are more likely to be born dead, to die shortly after birth, or to have some congenital malformation.
The economic level of the family is like wise a factor of importance, with the highest mortality rate occurring in families of the lowest economic levels. The poor prenatal diet of mothers in the low economic groups contributes to the high neonatal mortality rate. The greater the birth weight of the infant and the longer the gestation period, the lower the mortality rate in the neonatal period. Finally, neonatal mortality has been reported to increase with increasing birth order.