Breast feeding and labour Flashcards

1
Q

Advantages of breast feeding- health

A

Breastfeeding reduced the risk of: Gastroenteritis, chest infection, ear infections, urinary infections, diabetes, allergies, childhood cancers and SIDS, heart disease

Breast feeding reduces the risk of (mother): breast cancer, ovarian cancer, hip fractures

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2
Q

Formula milk

A
  • Water
  • Protein- cow milk protein and soy, 3 times as much protein as breastmilk, can cause weight gain in later years
  • Carbohydrate- Lactose
  • Fats- usually vegetable based, fat content in breast milk varies during feeds but in formula its static
  • Additives are added, unsure how long term this will affect health
  • A nutritionally adequate breast milk substitute
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3
Q

What do we need to discuss with mothers who choose to formular feed

A
  • Making up feeds correctly
  • Sterilisation of feeding equipment
  • First stage milks for first year
  • Amounts to give – link stomach size
  • Responsive bottle feeding
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4
Q

How to support a mother with breastfeeding

A
  • Keep mother and baby together – Room in.
  • Help mothers to recognise feeding cues
  • Allow unrestricted, frequent feeds
  • Support mothers to breastfeed at night, refer to ‘Caring for your baby at night Guide for parents’ Leaflet (Unicef.)
  • Avoid supplements
  • Avoid dummies
  • Support should start antenatally and continue through the postnatal period
  • One-to-one support from trained personnel at a time when the mother needs or is expecting it
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5
Q

Maternal standards

A
  • Ensuring pregnant women are prepared
  • Supporting closeness and feeding straight after birth
  • Ensuring breastfeeding off to a good start
    Informed decisions re other food for babies
  • Encouraging close and loving relationships
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6
Q

How are maternity standards provided

A

There is a breastfeeding assessment at 5 days. Within the first 7 days a minimum of 2 assessments are carried out. Specialist services can be provided to some mothers. Mothers should be signposted to social support in their local area

Formular- when giving feeds its encouraged to hold the baby close and give the majority of feeds themselvex

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7
Q

Benefits of breast feeding for the baby

A
  • Ideal food for newborns
  • Reduced risk of diarrhoea and vomiting
  • Reduced risk ear infections and chest infection
  • Less likelihood of becoming obese and T2 diabetes later in life
  • Breastmilk changes in composition and quality according to the baby’s needs – it is unique for that baby
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8
Q

Benefits of breast feeding for the mother

A
  • Reduces risk of breast cancer and ovarian cancer
  • Helps with weight loss (weight gained in pregnancy) as uses approx 500 extra calories per day for milk production
  • Less costly than formula feeding
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9
Q

Cons of breast feeding

A
  • It may be painful – sore and/or cracked nipples
  • Not enough milk leading to baby either losing weight or not gaining weight
  • Breast engorgement
  • Baby not effectively latching onto breast
  • Blocked milk duct
  • Mastitis
  • Breast abscess
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10
Q

Pros of formula feeding

A
  • It is difficult to identify any established scientific benefits of formula feeding. Most of the pros highlight the potential benefit of:
  • Family members sharing the feeding
  • Mothers don’t have to alter their diet with regards to alcohol and caffeine
  • More confident when feeding in public
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11
Q

Cons of formular feeding

A
  • Formula milk can be costly
  • It is not a ‘living’ product and cannot replicate all the qualities of human milk eg antibodies, enzymes, hormones, living cells etc
  • Risk of dehydration if not made correctly
  • Risk of weight loss if not made correctly (diluted)
  • Where access to clean water and/or boiled water formula feeding can cause major health problems.
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12
Q

How breastfeeding works

A
  • When the baby suckles this stimulates nerve impulses which stimulate the pituitary gland
  • Hormones are released causing milk let down
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13
Q

Prolcatin- hormone

A
  • Triggered by suckling
  • Acts on acini cells to make milk
  • Peaks 90 minutes after a feed
  • Suppresses ovulation
  • Needs to be stimulated early and frequently to be effective long term
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14
Q

Setting up milk production

A
  • Delivery of placenta opens prolactin receptor sites on acini cells
  • Prolactin surges ‘prime’ sites to begin milk production
  • Receptor sites start to close if not primed
  • Skin contact and lots of feeds in early days increase potential for long-term milk production
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15
Q

Oxytocin

A
  • Triggered by suckling and positive thoughts
  • Acts in the myoepithelial cells to eject milk
  • Largest peak occurs early in the feed
  • Effect may be felt as tingling
  • Basal levels are higher when the baby is near
  • Can be temporarily inhibited by stress
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16
Q

Prolactin and oxytocin

A

Work together to trigger feeling of love and mothering behaviour, induce calmness and a feeling of well being. Enhance the mother baby bond.

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17
Q

Colostrum

A
  • Produced from 16 weeks gestation, continues for 3-4 days postpartum
  • Yellow-orange thick fluid: concentrated form of breast milk
  • Lower levels of carbohydrate and fat
  • Newborns have immature kidneys and only able to cope with small volumes of fluid
  • Having small amount of colostrum allows infant to learn co-ordination of sucking, swallowing and breathing.
  • Has a laxative effect – aids passage of meconium from the gut
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18
Q

Contents of colostrum

A
  • Rich in growth factors
  • White cells and antibodies (especially IgA)
  • Fat soluble vitamins (especially vitamin A)
  • Protein minerals
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19
Q

What’s contained in breast milk- fat and protein

A
  • Fat- main source of energy, half of all calories. Mainly triglycerides. Long chain fatty acids aid brain and eye development, nervous and vascular system
  • Protein- about 40% casein (carry calcium and phosphate) and 60% whey (contains anti-infective proteins). Lactoferrin binds to iron. Bifidus factor inhibits growth of harmful bacteria in the gut. Taurine is required for conjugation of bile salts and absorption of fats.
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20
Q

Whats contained in breast milk- carbohydrates and iron

A
  • Carbohyrates- Lactose is the main carbohydrate, its quickly broken down into glucose and is important for brain growth
  • Iron- low levels are bound by lactoferrin. Artificial milk has higher levels which promote growth of bacteria in the gut and risk of infection.
21
Q

What contained in breast milk- electrolytes, minerals and pre-biotics

A
  • Electrolytes and minerals: sodium, potassium, chloride, calcium, phosphorus and magnesium
  • Pre-biotics: interact with intestinal epithelial cells to stimulate the immune system. Reduces gut pH causing infection to prevent pathogenic bacteria and the number of bifidus bacteria on the mucosa
22
Q

Breast milk- fat soluble vitamins

A
  • Vitamin A & E levels adequate
  • Vitamin D & K not always at desired level ( current guidelines are to supplement)
  • DoH recommend Vitamin D supplementation
  • Vitamin K routinely administered to infants
  • As infants gut is colonised Vitamin K levels rise
23
Q

Breastmilk- immunoglobulins

A
  • Cannot be replicated in formula milk

Present in 3 ways:
* Antibodies from previous maternal infections
* Secretory IgA which lines the digestive tract
* Entero-mammary and broncho-mammary pathways

24
Q

Breast milk production amount

A
  • At birth: up to 5ml
  • Within 24 hours: 7-123 ml/day
  • Between 2-6 days: 395-868 ml/day
  • 4 weeks: 395-868 ml/day
  • 6 months 710-803 ml/day
25
Q

Bracho-mammary and Entero-mammary pathway

A

When pathogens are inhaled (broncho) or ingested (entero). Antibodies are produced by the mother and incorporated into the breast milk.

26
Q

Baby’s instinctive behaviour

A

Birth cry, relaxation, awakening, activity, crawling, resting, familiarisation, suckling, sleeping

27
Q

Skin to skin contact

A
  • Stimulates release of prolactin and oxytocin
  • Calms and relaxes baby and mother
  • Regulates baby’s heart rate and breathing
  • Regulates baby’s temperature
  • Stimulates breast-seeking behaviour and interest in feeding
  • Stimulates endorphin release
  • Protects baby from infection

Can help with: positioning and attachment, unsettled babies, breast refusal, postnatal depression

28
Q

What defines a normal labour

A
  • Spontaneous in onset
  • Regular, painful contractions
  • Progressive dilatation and effacement of the cervix
  • Spontaneous vaginal delivery
  • Vertex position
  • Between 37 and 42 weeks
  • Mother and infant in good condition
29
Q

What are the cardinal movements and most common presentation

A

Cardinal movements- 7 movements which allows the fetal head to move through the pelvic floor.

Most common presentation- longitudinal cephalic line.

30
Q

Cardinal movements 1-3

A
  • Engagement- largest diameter of the fetus head fits into the largest diameter of the maternal pelvis. Thne moves towards the pelvis brim in either the left or right occipto-transverse position.
  • Descent- the baby descends through the pelvic inlet towards the pelvic floor. Occurs due to uterine contraction, amniotic fluid pressure and abdominal muscle contractions.
  • Flexion- fetal head meets the pelvic floor and cervical flexion occurs. Allows foetus to be sub-occipito bregmatic. In this position the fetal skull has the smallest diameter
31
Q

Cardinal movements 4-5

A
  • Internal rotation- pelvic floor has a gutter shape (forward and downward slope), causes the head to rotate from a left or right occipto-transverse position to an occipto-anterior position.
  • Crowning- largest diameter of the fetal head goes through the narrowest part of the bony pelvis. The head is visible at the vulva and no longer retreats between contractions.
32
Q

Cardinal movements 6-7

A
  • Extension- the occiput slips beneath the suprapubic arch as the head extends, the nape of the neck pivots against the arch. Extension of the head causes stretching of the perineum.
  • External rotation and restitution- the head externally rotates to face the right or left medial thigh of the mother. The shoulders rotate from a transverse position to an anterior-posterior position. The re-alignment of the shoulders with the head is restitution.
33
Q

Onset of labour

A
  • Maternal factors: rise of oestrogen/prostaglandin, Formation of oxytocin receptors
  • Physical factors: stretching of uterus, pressure of presenting part on the cervix
  • Fetal factors: fetal pituitary/adrenals
34
Q

Labour- the passage

A
  • Head enters the pelvis transversely, it descends in this position through the mid cavity
  • It internally rotates when it hits the pelvic floor to exit in the AP diameter
35
Q

Labour- the passenger and the powers

A

The passenger
* Attitude- degree of flexion of the fetal head
* Position- 95% are occiput anterior

The powers- contractions start in the fundus and spread downwards through the myometrium. Regular, strong contractions are essential to enable progress in labour

36
Q

The three stages of labour

A
  • First stage: onset of labour to full dilation of the cervix
  • Second stage: full dilation to delivery of baby
  • Third stage: delivery of baby to delivery of placenta and membranes
37
Q

First stage of labour

A
  • Latent phase: painful contractions often irregular. Cervical changes (softening/effacement). Dilation up to 4cms
  • Active stage: regular painful contractions and progressive cervical dilation up to 10cm
  • On average- 12 hours if primigravida and 7 ½ hours multiparous

Normal progress in 1st stage: 2cm in four hours

38
Q

Progress in labour

A
  • Varies between individuals
  • Effacement (thinning)
  • Dilatation (opening)
  • Descent (progress through the birth canal)
  • Progress assessed by vaginal examination
  • Cervix moves from posterior to anterior
39
Q

Descent

A
  • Defined relative to the ischial spine
  • 0 station= top of head at the spines
  • +2 station= 2cm below the ischial spine
40
Q

Fetal monitoring in low risk labour

A
  • Intermittent auscultation using Doppler or Pinards stethoscope
  • For one minute
  • Following a contraction
  • Every 15 minutes in the first stage
  • Every 5 minutes in the second stage
41
Q

Labour- analgesia

A
  • Non-pharmacological: supportive birth partner, TENS, Birthing pool, Acupuncture
  • Pharmacological: oral analgesia, Entonox, Opiate + anti-emetic, epidural
42
Q

Second stage of labour

A
  • Passive: from full dilation, allows spontaneous descent of presenting part, may have some involuntary urge to push, may see some anal dilation
  • Active second stage: mother is encouraged to actively push, fetal head descends- perineum stretches. Head is delivered and the body with the next contraction.
43
Q

Mechanism of delivery

A
  • Descent thro the pelvis
  • Flexion of the head: (chin to chest)
  • Internal rotation: transverse diameter to AP
  • Crowning of the head
  • Extension: face sweeps the perineum
  • Restitution: Head rotates to align with shoulders
  • Internal rotation of the shoulders
  • Expulsion: Shoulders delivered in AP diameter
    Baby delivered in OA position
44
Q

Moulding and Caput succedaneum

A

Moulding: overlapping of the fetal skull bones at the suture line. Occurs during labour as the fetus descends through the pelvis

Caput succedaneum: temporary swelling of the soft parts of the head due to compression by the muscles of the cervix. Crosses suture lines

45
Q

At birth

A
  • Baby is delivered onto the mothers abdomen
  • Delayed cord clamping allows blood to flow from the placenta to the baby
  • Clamp cord approx. 2cm away from the babys abdomen
  • Baby placed in direct contact with mother’s skin and dried with pre-warmed towels. Initial assessment of baby’s condition.
  • Early mother baby contact to be encouraged.
  • Assess for perineal trauma and manage as appropriate.
46
Q

The third stage of labour

A
  • Can be active or physiological
  • Physiological: can take up to an hour. Watch for signs of placental separation. Uterus well contracted at the level of the umbilicus. A sudden gush of blood, lengthening of cord
  • Monitor for signs of excessive bleeding- increased risk of PPH
47
Q

The third stage- active management

A
  • IM injection of oxytocin (uteronic drug) following birth
  • Observe for signs of separation
  • Controlled cord traction
  • Guard the uterus
48
Q

Perineal trauma assessment

A
  • 1st degree- skin around the fourchette
  • 2nd degree/Episiotomy- skin plus vaginal wall and perineal muscles
  • 3rd degree- all of the above plus anal sphincter
  • 4th degree- most severe, all of the above plus rectal tissue