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Unit 7 > Birth and Lactation > Flashcards

Birth and Lactation Flashcards

1
Q

What are the potential causes of the onset of labour?

A

Is multifactorial, science is till uncertain of the specific cause. Potentials include:
-progesterone withdrawal theory - contractions can start due to decreased sensitivity to progesterone, which removes the inhibitory effect on the contraction of smooth muscle.
-Fetal factors increased cortisol.
-Corticotrophin releasing hormone

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2
Q

What is the corticotrophin-releasing hormone in the theory of the onset of labor?

A

CRH is produced by the hypothalamus during times of stress.
This causes the pituitary gland to produce ACTH (adrenocortcotropic hormone)
This travels to the adrenal gland to release hormones to increase energy levels and cope with stress.
During pregnancy placenta releases CRH into maternal bloodstream, however, the availability is regulated by CRH binding protein which remains the same.
Just before labor CRH increases and CRH bp decreases.
CRH stimulates prostaglandin release and oxytocin in stimulating myometrium contractions. CRH is converted to estradoil which inibits prostaglandin production.
CRH may also act directly on receptors to increase contractions.

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3
Q

What is labour?

A

The process through which the fetus, placenta and membranes are expelled through the birth canal.

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4
Q

What composes a normal labour?

A

Spontaneous onset
Gestation of 37 weeks plus
Baby is in the vertex position (head down)
Completed within 18 hours with no complications

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5
Q

What is expulsion of the foetus from the uterus called before 24 weeks?

A

Miscarriage (early or late)
However, advances in neonatal care may allow for active resusctiation of some babies from 23 weeks.

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6
Q

What are the two phases of labour?

A

Latent
Active
These are both part of the first stage of labour.

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7
Q

What happens during the latent phase of labour?

A

Presence of uterine contraction and cervical dilation
Effacement up to 4cm

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8
Q

What happens during the active stage of labour?

A

Regular contractions and progessive dilation beyond 4 cm

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9
Q

What is effacement during labour?

A

The softening, thinning and shortening of the cervix.
Measured in %
Reponse to presssure on the cerix by the presenting part of the foetus.

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10
Q

What is the difference between effacement and dilation?

A

Effacement is the cervix thinning
Dilation in the cervix opening

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11
Q

What happens in the first stage of labour?

A

Includes the active and latent phase
The cervix reaches 10cm dilated, regular and rhythmic contractions are present.

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12
Q

What happens during the second stage of labour?

A

From full dilation of the cervix to delivery of the baby

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13
Q

What happens during the third stage of labour?

A

Baby has already been delivered, to the delivery of the placenta and membranes.
This may be active (30 mins) - intervention from midwife
or physiological (60mins) - natural process only

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14
Q

What is the normal rate of progress of feotal movement in an established labour?

A

0.5cm per hour

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15
Q

What is the 4P theory of labour?

A

That cervical effacement, dialtion and expulsion of the fetus and after birth is dependent on.
Power - of uterine contractility and maternal effort
Passage - maternal bony pelvis or soft tissue of birth canal
Passenger - presentation or position of the fetus
Psych - confidence, encouragement and positive affirmation.

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16
Q

What is the importance and detail behind the power of uterine contractions during labour?

A

Involuntary uterine contractions are the primary force that dilate and efface the cervix before voluntary maternal pushing kicks in.
Contraction begins at the fundus or cornua, which contains the number of myometrial cells, then spread outwards and downwards becoming less intense.
The upper segment thickens and shortens propelling the foetus down the birth canal.
The lower pole dilates to allow expulsion of the feuts.

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17
Q

What is meant by fundal dominance during labour contractions?

A

Contraction begins at the fundus or cornua, which contains the number of myometrial cells, then spread outwards and downwards becoming less intense.
upper segment contractions are more active, more intense and longer lasting.

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18
Q

What is meant by polarity of the uterus contractions?

A

The upper uterine segment contracts whilst the lower uterine segment dilates to accomodate the downward movement of the foetus.

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19
Q

What is the important of retraction and contraction during labour?

A

Retraction means that the muscle fibres do not completely relax inbetween contractions, this means they maintain some of their shortening.
This allows progressive shortening and thicking of the uterine segment.

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20
Q

Why are normal uterine contractions described as waves?

A

Composed of an increment - building up
Acme - peak
Decrement - descending portion

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21
Q

Why does the shape and size of the pelvic cavity influence the position of the foetus during labour?

A

The pelvic inlet is widest in the transverse plane, hence the baby descends into this area in an occipito transverse position
The pelvic cavity is circular so all diameters are the same, this allows the baby to rotate within this section.
The pelvic outlet is widest in the anterioposterior plane, hence the baby is expelled in an occipitoanterior position.

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22
Q

What feature of the coccyx plays a role in labour?

A

The coccyx has slight mobility so it can increase the available space in the pelvic outlet.

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23
Q

What roles do the soft tissue of the birth canal have during labour?

A

The soft tissues of the cervix, vagina and perineum stretch to allow passage of the fetus.
Progesterone and relaxin help facilitate the softening and increase in elasticity of these muscles and ligaments.

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24
Q

What features of the passenger (feotus) play a role in labour?

A

Lie - long axis of the foetus compared to the long axis of the uterus
Presentation - breech, cephalic, shoulder
Presenting part - part of the feturs that lies in the pelvic brim or lowest of uterus
Attitude - relationship of the fetal head and limbs to its body (fully flexed, deflexed, extended etc)
Denominator - the part of the feotus used when referring to the position of the presenting part e.g occiput, sacrum
Position - relationship of the denominator to six key points on the maternal pelvic brim (lateral, posterior etc)

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25
Q

When can birth occur, can not be prevented?

A

When the widest presenting transverse diameter has passed the brim of the pelvis.
This is 9.5cm wide in cephalic presentation (hence require 10cm dilation)

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26
Q

What are the different foetal lies?

A

Foetal lie is the long axis of the foetus compared to the long axis of the uterus
Common lies include: oblique, longitudinal, transverse

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27
Q

What are the different types of breech baby?

A

Frank breech (bum first)
Full breech - bum and feet first (legs still curled up)
single footing breech - one foot first
Footing breech - both feet first.

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28
Q

What are different presenting parts in a foetus?

A

Occiput
Face
Brow
Breech
Shoulder

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29
Q

What are some examples of different foetal attitudes?

A

Describe the location of the foetal head in comparison to its body and limbs.

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30
Q

What fetal denominators align with what fetal presentations?

A

Cephalic : occiput
Face: mentum (chin)
Breach: Sacrum
Shoulder: Acromion
Brow: Frontal eminence

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31
Q

What is the best foetal position for a vaginal birth

A

A direct occipital anterior - smallest diameter presents in the pelvis, encourages perineum to stretch not tear
Spontaneous vaginal deliveries are possible with occiput posterior and mento anterior positions

32
Q

What is meant by engagement of the feotus?

A

When the widest transverse diameter of the presenting part (often the biparietal diameter) has passed through the pelvic inlet
This is measured in fifth
When more than 2/5s of the foetal head is palpable the feotus is not head engaged.
Engagement normally coours from 38 weeks gestations

33
Q

What is the widest diameter of the fetal skull?

A

Occipitofrontal diameter

34
Q

Why is psyche important during labour?

A

Contractions are involuntary.
Emotional disturbances can temporarily abolish contractions.
Maternal fear or tension increases (nor)adrenaline with stimulates alpha and beta receptors to interfere with the rhythmic nature of labour.
Anxiety can also increase pain perception and lead to an increased need for analgesia and anaesthesia.

35
Q

What causes the foetus to descend in the birth canal?

A

Direct pressure from contractions, maternal effort and pressure from the amniotic fluid.

36
Q

Give an overview of the mechanisms of birth for the foetus

A

The head enters the pelvic brim in the occiput transverse position.
The neck is flexed
Uterine activity caused the foetus to descend and engagement occurs
Internal rotation
Extension
External rotation and restitution.

37
Q

Give the detailed mechanisms of birth in terms of the foetal journey.

A

The foetal head enters the pelvic brim in the OT position
As the fetus descends due to direct pressure is means resistance causing the head to flex.
Once the occiput reaches the pelvic floor the foetal head rotates to the OA position.
The head continues to descend until is reaches the ischial spines where is extends.
The extended feotal head distends the vulva.
Once the head is delivered is rotates back to thw OT position to realing with the shoulders.
The shoulders are then delivered by acial traction

38
Q

What is shoulder dystocia?

A

Where there is difficulty delivering the fetal shoulders after the head has been fully delivered, this is an obstetric emergency.

39
Q

What are some common complications in labour?

A

Failure to progress
Fetal distress
Sepsis - from infection
Retained Placenta
Uterine inversion
Haemorrhage
Perineal Trauma

40
Q

What is cephalopelvic disproportion?

A

When the babies head is too large to fit through the mothers pelvis
Often requires a c-section, with a vaginal delivery being impossible or very high risk

41
Q

What is uterine inversion?

A

When the placenta remains attached to the uterus, hence the dispulsion of the placenta also pulls the uterus out.

42
Q

What is an episotomy?

A

When a cut is made between the vagina and the perineum/anus during labour
This widens the passage available for a vaginal delivery and decreases the risk of a perineal tear.
Perineal body cut is less painful than the tearing of a perineal muscle

43
Q

What is fetal distress?

A

A general sign that the baby is not doing well
When the baby is not receiving enough oxygen, has changes in heart rate, low amniotic fluid or decreased movement.

44
Q

What is the baby friendly initiative?

A

A WHO/UNICEF campaign to improve healthcare understanding and practise around infant feeding and bonding.
Is included within the NHS 2019 Long Term Plan
Includes information of the constituents of human milk, protective and developmental functions of breast milke and the role of breast feeding in public health.

45
Q

What are the different stages of lactation?

A

Lactogenesis 1 - breast development, alveolar epithelial cells become lactocytes and colostrum production from 16 weeks gestation
Lactogenesis 2 - increased milk secretion between 32 and 96 hours post birth, due to increase prolactin and decreased pregnancy hormones
Lactogenesis 3 - maintaining a consistent rate of milk production for 10 days post natal. Less reliant on prolactin and more reliant on Feedback Inhibitor of Lactation.

46
Q

What is lactogenesis?

A

Cellular changes by which mammory epithelial cells switch from a growing non-secretory tissue to a secreting non growing tissue, allowing the production of breast milk.

47
Q

What are the physical changes to the breast in preparation for lactation?

A

Larger and tender due to ductal growth
Areola and nipple darken
Montgomery’s tubercles appear of areola, these glands secrete antiseptic sebum as lubrication also produces a smell to attract the baby.
Fair skinned women may have marbling as blood supply to the breast increases.

48
Q

Explain the anatomy of the breast relevant to the production of breast milk

A

Breast is made up of mammary glands
This consists of 15-20 lobes in a bike spoke like fashion
Each lobe consists of many lobules, each lobule contains alveoli made of mammary secretory epithelial cells (lactocytes).
These converge onto the lactiferous duct which travels towards the nipples and widens towards the nipple as the lactiferous sinus.
These sit within the breast stroma made of adipose tissue and suspensory fibrous ligaments

49
Q

What is the purpose of myoepithelial cells in the breast during lactation?

A

Series of muscle cells, contract sycnchronised to help move milk from the lactiferous ductules towards the opening of the nipple.

50
Q

What hormonal control initiates breast milk production?

A

Increase in prolactin and oxytocin secretion from the pituitary gland triggered by the smell, sight and touch of the infant. , combined with a decrease in pregnancy hormones oestrogen and progesterone after placenta delivery

51
Q

What hormones cause breast growth during pregnancy?

A

Increased oestrogen, progesterone and human placental lactogen cause the ductal system and alveolus to grow in size.

52
Q

Describe the hormonal role of prolactin

A

Milk production
Increase after touch and stimulation, peaks 45 minutes into breast feeding.
Higher levels at night
Frequent contact and feed establishes a regular prolactin level system and long term production of breast milk

53
Q

Describe the hormonal role of oxytocin

A

Milk delivery
Acts on muscles in the pulsatile action to cause milk to leave the nipple
Higher levels when the baby is near
High stress can temporalt ‘let down the reflex’

54
Q

What is the positive feedback mechanism in breast milk production?
Why is this important clincally?

A

Lactocytes contain prolactin receptors
Prolactin levesl rise in blood stream from suckling from the baby
Higher lever of prolactin activates more lactocytes to produce milk and increase the number of prolactin receptors.
Until eventually the maximum number of primed lactocytes is reached.
This triggers the mothering response.

Mothers that are struggling to breast feed are encouraged to feed little and regular, to increase the frequency of prolactin stimulation

55
Q

What is important about the way a baby feeds and the removal of breast milk?

A

Fat globules adhere to the inner walls of the alveloi and lactiferous ducts.
These are best removed by the flutter suckling a baby does towards the end of a breast feed.

56
Q

What happens to breast feeding hormone levels if a woman does not want to breast feed?

A

During the first week after birth prolactin levels in breastfeeding women fall about 50%.
If a mother does not breastfeed prolactin returns to non-pregnant levels seven days postpartum.

57
Q

What happens to prolcatin levels whilst breastfeeding? in the actual moment and the period of time

A

During the moment of breast feeding levels will increase peaking 45 minutes into the feed, then gradually decrease
Remain elevated for years as long as the mother continues breast feeding.

58
Q

Why, related to levels of oxytocin, is it important to be aware of a baby’s early signal that it wants to feed?

A

Early detection of feeding signals lead to a more peaceful feeding environment, oxytocin increases when baby is near
If mother waits until the baby is crying, maternal stress and cortisol may increase, Cortisol will compete with oxytocin, may cause failure in oxytoxin signalling so breast milk is not delivered and the feed is failed.
Cortisol and adrenaline causes muscle around the breast to tighten.

59
Q

What are the psychological effects of prolactin and oxytocin?

A

Increase mothers sense of calm and protectiveness around her new baby.
Oxytocin - love hormone - helps form a bond between a mother and baby.
Primitlvy would increase offspring survival rates
Referred to as the mothering hormones.

60
Q

What is the role of feedback inhibitor of lactin on breast milk production?

A

When breasts become overly full of breast milk either by ineffective milk removal or long spaces between feeding FIL protein is produced
This down regulates milk production
THis is also aided by increased pressure within the breast changing to shape of prolactin receptors making it more difficult for prolactin to bind.

61
Q

What health benefit does oxytocin have on the mother?

A

Receptors found mainly in the uterus and mammary glands but also the stomach, kidneys, blood vessels, heart and brain
- neuropeptide - falling in love with the baby, trust hormone, social bonding (also rises in dad) can help keep families together
- competes with cortisol - decrease BP, boost immune system
- oxytocin working on the breast may also help eliminate carcinogenic cel;s

62
Q

What are the special features of colostrum?

A

‘concentrated breast milk’
Breast milk contains everything and more than that in colostrum
Colostrum has different quantities, adapted for the essential nutrients in the initial feed.

63
Q

What does colostrum contain/not contain that is beneficial to the baby?

A

Works as a laxative to help pass bilirubin preventing jaundice
Has a low proportion of water, baby is born with excess interstitial fluid, excess water could overwhelm the immature kidney’s. - healthy term babies will not become dehydrated in the first couple of days.
Anti-inflammatory properties - gut health
Encourages proliferation of cells and villi in the gut - gut maturation.

64
Q

How does breast milk composition compare to formula milk?

A

Breast milk contains many more live constituents
More lactose
Higher engery component
More digestable
Less salt
Less protein
Immune componenets - leukocytes and antibodies

65
Q

What benefits does breast milk give the baby over formula milk?

A

Water in breast milk is filtered - environmental water used to make formula may not be sterile
Protein in bm is maore whey based so more digestable, decrease cancer risk. Formula milk increase risk of diabetes
Fats - different types of fats, bm better support neural development
Vitamins - formular milk has different proprtions of vitamins leading to excess/decreased in baby, in order to reach shelf life
bm has growth factors tailored to the babies level of development (more in premature)
Transfer factors in bm to aid absorption of nutrients
Stem cells as an internal repair system
Immunoglobulins tailored to environment of mother (same as baby)

66
Q

What in breast milk aids the development of the babies immune system?

A

Leukocytes
Immunoglobulins - tailored to the mothers environment (same as babies)
Oligosaccharides -simple sugar for energy, helps build up gut microflora.
Milk lipids - damage outer surface of viruses
Enzymes to destroy bacteria
IL-7 - development of the thymus
Cytokines

67
Q

List all the substances found in formular milk

A

Vitamins and mnerals
Fats
Carbohydrates
Protein Water

68
Q

What is found in human milk that is not found in formular milk?

A

Cytokines including IL-7
Enzymes
Milk lipids
Oligosaccharides
Lactoferrrin
Leukocytes
Immunoglobulins
Stem Cells
Lymphocytes
Growth Factors

69
Q

What is lactoferrin?

A

Found in breast milk
Assists the absoprtion of iron
Reduces the amount of free iron, decreases attraction of bacteria

70
Q

What signs show that the baby is successfully breastfeeding?

A

Swallowing is audible and visible
Sustained rhythmic sucking
Mouth wide open
Arms and hands are relaxed
Mouth is moist
Minimal discomfort
Mums feel sleepy and relaxed
Less areola visible underneath the chin then above the nipple
Nose free
Chin touching breast
Lower lip rolled down.

71
Q

What are some of the benefits of breast feeding to the mother?

A

Lowers rates of type 2 diabetes,
Decreases blood pressure
Decreases rates of hearts disease
Reduces the risk of breast and ovarian cancer
Cheaper
High prolactin decreases FSH levels, this can delay ovulation having a mild contraceptive effect, however the effect decreases further after birth, you can still get pregnant whilst breastfeeding.

72
Q

What are some of the disadvantages of breast feeding to the mother/parents?

A

Engorged breasts are painful, heavy and sensitive
Mastititis (inflammation of breast tissue), can cause breast abscess if not treated properly
Pain - blocked ducts, nipple trauma
Partner feels unable to help.
Still born - lactation still occurs, many women require medication to suppress breast feeding due to the emotional trauma

73
Q

What is important to remember about medication and breast feeding?

A

Some medications are contraindicated for breast feeding mothers.
Reluctance to give breast feeding mothers medication
Needs checking on NICE guidelines before any medicine is taken

74
Q

What are WHO recommendations regarding the timespans of breast feeding?

A

Exclusivly breastfeeding until 6 months of age
Then given complimentary food alongside breast feeding until 2yrs or beyond.

75
Q

What protocols/methods are used to encourage breastfeeding?

A

Education - information and advertising
Safe, relaxing and supporting environments - cafes allowing breast feeding or having breast feeding corners
Support groups
Encouraging skin to skin
Reassuring women.
Avoid seperating mothers and babies

Unit 7 (20 decks)

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