CBL 8: Newborn_first 24 hours and adaptations and discomfort of pp_safe sleep

Question 1

What are you checking in prenatal visits (normal ranges)? (5)

Answer 1

1. Blood pressure (systolic 100-140 / diastolic 60-90)
2. Symphysis fundal height (+/ 2-3 cm of GA, routinely gaining about 1 cm per week; use top of pubic bone as anchor and measure to the top of the fundus) {variation – in care provider, baby may have dropped, long/short waisted people may measure differently)
3. Position (start with the fundus, lateral, pawlick’s, pelvic) – looking for fetal pole (cephalic with homebirth; checking for position)
4. Fetal movement – observe; ask parent have you been feeling regular movement following babes regular patterns? Where are you feeling the kicks? (6 movements in 2 hours)
5. FHR – intermittent auscultation (doppler; pinard; fetoscope)110-160, acels are good, regular rhythm, decels 15 of 15 beats below baseline; listen for minute; listen over the fetal back

Question 2

How often check vital signs of adult immediate pp?

Answer 2

HR, RR, BP, Bleeding, Uterus: q 15 mins for first hour
Temp – once in first hour
All signs at 2 hours.

Question 3

What are you observing in adult in immediate pp? (9)

Answer 3

Vital signs
uterus (at umbilicus +/- 1)
Bleeding
Perineum
Bladder/Bowels (has voided)
Breast/Nipples
Ambulation
Pain/Comfort, Emotions
Dyad (first feed within 1-2 hours)

Question 4

When take APGAR score?

Answer 4

1, 5, 10 mins

Question 5

What is being looked at in APGAR score (5)

Answer 5

HR (>100 bpm)
RR (good, crying)
Reflex response (cough, sneeze, cry)
Muscle tone (active/flexed)
Colour (completely pink)

Question 6

Normal APGAR?

Answer 6

7-10

Question 7

Normal newborn measurements?

Answer 7

Weight: for term infants is 2500 – 4500 g
Height: 46 to 54 cm
Head Circumference: 31-38cm

Question 8

How often nb vital assessments?

Answer 8

RR, HR, Temp initially, then every 15-30 mins in first hour
30-60 mins second hour
(RR- full min; HR – full min initially, then 30 seconds if normal)

Question 9

Normal nb findings?

Answer 9

RR: 40-60 breaths/minute (may be 30-60 in first 12 hours)
HR:100 -160 bpm
Temp: (axillary) 36.5-37.5 C

Question 10

What form do you fill out for record of birth at homebirth?

Answer 10

Community Liaison Record NEWBORN

Question 11

PSBC Guideline on bedsharing?

Answer 11

Recent evidence supports that there is no increased risk for sudden, unexpected infant death during sleep among healthy breastfeeding infants that bedshare in the absence of known risk factors (i.e., breastsleeping)”

Question 12

3 things when counselling on safe sleep?

Answer 12

Sleep environment
Sleep position
Sleep surface

Question 13

What is the min duration recommendation for room sharing?

Answer 13

6 mo

Question 14

What are the risk factors of bedsharing? (7)

Answer 14

Smoking (household)
Drinking (anyone in the bed)
Breastfeeding
Baby on Back
Baby not swaddled
Healthy baby full term
Safe sleep surface (firm mattress, no extra pillows heavy blankets)

REVIEW BEDSHARING/COUCHSHARING UN-INTENTIONALLY

Question 15

Normal newborn breathing?

Answer 15

May be irregular/breathing in clusters/grunting

Question 16

Not normal nb breathing?

Answer 16

High pitched sound while breathing and flaring nostils.

Question 17

Early hunger cues?

Answer 17

Stirring, REM during sleep
Sucking sounds, soft cooing, sighing
Mouth opening
Hand to mouth/licking movements
Rooting

Question 18

Late hunger cues?

Answer 18

Fussiness/irritability
Exhaustion
Sleep
Crying

Question 19

Best ways to prevent hemorrhoids?(6)

Answer 19

drink fluids
diet high in fibre, fruits& veggies
exercise
Sitz baths
Anusol (bisthmuth oxide, zinc oxde)
Preparation H (phenylephrine)

Question 20

10 Bs of postpartum care?

Answer 20

Baby
Breasts
Bladder
Belly
Bottom
Bowels
Bleeding
Baby blues/BRAIN
Birth control
Blood work

Question 21

What bleeding ISN’T normal pp?

Answer 21

Clot bigger than a plum. Bleeding that fills 2 pads in an hour.

Question 22

Services available to pp midwifery clients?

Answer 22

Immunizations, hearing screen, TCB, right from the start, STI screening

Question 23

Normal physiological changes: pp vital signs?

Answer 23

Within normal limits. Milk temp increase on day 2-3

Question 24

Normal physiological changes: Uterus

Answer 24

Immediate: central, firm, at umbilicus
First week: after pains 72 hours, decrease by 1-3 cm below umbilicus;
1-6 weeks 1-3 cm below umbilicus per day, below pubic bone after day 14

Question 25

Normal physiological changes: Bleeding?

Answer 25

Immediate: moderate, dark red, clots
First week: decreasing colour/amount, red-pink, clots
2-6 weeks: pink, mucosy discharge then brown spotting

Question 26

Normal physiological changes: Perinium?

Answer 26

Immediate: swollen, bruised, tender
First week: decrease tenderness and bruising each day
Week 1-6: Minimal discomfort, well approximated, no bruising

Question 27

Normal physiological changes: Bladder/Bowels?

Answer 27

Immediate: No bowel activity, some difficulty voiding
First week: Increased urine output, mild urinary incontinence, bowel function returns, constipation common
1-6 weeks: Normal function

Question 28

Normal physiological changes: Breast/nipples?

Answer 28

Immediate: Soft breasts, nipples intact, small drops of col
First week: milk production day 2-4, mild engorgement, tender, sore nipples
1-6 weeks: Breasts full before feeding and soft after; nipples intact non tender