CBL 8_Perineal health, Newborn transient tachypnea & hypothermia Flashcards
Can prenatal perineal massage prevent tearing? (4)
Mixed evidence - hard to standardize.
Evidence says Antenatal perineal massage starting at 34-35 weeks GA:
* reduce perinial trauma for nulips (particulary 3-4 degree tears)
* better wound healing
* less pain
* less incontinence
What can be done to prevent tearing in labour? (3)
Warm compresses significantly reduce 3-4 degree (moderate quality)
Hands off may reduce episiotomy (low quality)
Positions - side lying, all fours
Cochrane: “Further research could be performed evaluating perineal techniques, warm compresses and massage, and how different types of oil used during massage affect women and babies. It is important for any future research to collect information on women’s views.”
“(T)he research we have on warm compresses seems to be encouraging. It does seem to significantly reduce the risk of severe tears. There’s some mixed evidence on whether or not they prevent episiotomy and increase intact perineum, but one study found a much lower risk of urinary incontinence and lower pain during birth and postpartum. Therefore, because of these findings, the use of warm compresses should be routinely offered to birthing people for their comfort since there is no risk and only the potential for benefit for lowering severe tears. One study by Healy et al said that there is, ‘high-quality evidence suggests that compresses immersed in warm tap water increase the incidence of intact perineum. This low-cost, highly effective intervention could easily be implemented in all birth settings.’ “…
Hands on or hands off/hands poised?
(RCT- 3, Obs -2)
Continues to be debated.
RCT - hands poised:
lower episiotomy rates
intact perinium
less pain
Observational studies:
found hands on is protective IF experienced/trained providers and a setting with low rates of tearing.
What is OASI care bundle in UK?
- Discuss OASI prenatally and discuss what can reduce tears prenatally
- Manual perineal protection while communicating to encourage slow/guided birth
- IF CLINICALLY INDICATED: mediolateral episiotomy performed at 60 degree angle from the midline of crowning
- Systematic examination of vagina and ano-rectum even if perineum appears intact.
What positions may be best for tearing?
Hands and knees
Side Lying
Best practice with delivery of head?
Birther encouraged to stop pushing and allow the delivery to progress by uterine contractions
Communicate : suggest panting, gentle blowing, horse lips etc (do NOT “PUSHPUSHPUSH!).
What does evidence based birth say on tearing? (6)
-Who you choose as your care provider, is one of the strongest predictors of whether you’ll have an intact perineum
Wisdom for facilitating intact perineums/ reducing perineal tears;
* Calm controlled birth
* Patience with birth of head and gentleness with the birth of the shoulders (remember posterior shoulder often born first)
* H & K birth position preferred or side lying if not possible
* Spontaneous pushing – don’t push during crowning
* Good communication with birther (as needed) during birthing process
* In an effort to avoid an expulsive push/ tear in a fast progressing birth, encourage the birther to give small pushes at crowning so the head is born slowly between contractions
What should you avoid for tearing? (4)
AVOID
* forced/ directed pushing
* Valsalva
* supine positioning
* unnecessary manipulation/ fiddling at perineum (eg; Posterior shoulder shown to be born first despite what the textbooks say!)
Is posterior or anterior shoulder usually born first?
Posterior despite all the literature saying anterior
Still don’t know why lol
What immediate therapy that can promote healing of the perineum? (7)
- ice
- analgesics
- anti-inflammatory agents such as ibuprofen for the first two to three days
- sitz baths with Epsom salts
- keeping area clean and dry
- During urination, pouring warm water over the area can reduce the stinging from the acidity of the urine
- Developing strategies for keeping the birther off her feet
What are newborn benefits of golden hour/immediate STS (delaying NB exam/seperation for this time)? (5)
- Maintenance of thermoregulation
- Improved blood glucose levels
- Reduced incidence of crying
- Reduced pain reaction
- Improved rates of energy conservations
What are bf benefits of golden hour/immediate STS (delaying NB exam/seperation for this time)? (4)
-Increased rates of initiation and duration
-reduced pain association w engorgement
-decreased rates of anxiety
-increased nb recognition of mother’s own milk
what are the key steps in performing a newborn assessment (review from last term)?
- Hx (any risk factors?)
- Observation – appearance, colour, tone, behaviour incl breathing effort, whimpering etc
- Objective measurements (VSS)
- Head to toe exam (incl reflexes)
What should you include in a nb exam?(6)
- observation
- inspection
- auscultation
- palpation
- percussion
- documentation
What might indicate a healthy vs unwell newborn?(4)
- VSs
- observation (incl SPO2)
- reflexes
- behaviour
Normal nb breathing?
-may breathe in clusters (shallow and rapid_deep and slow other times)
-may be irregular
Normal nb colour? (3)
-blue/purple feet and hands in first 24 hours
-blotchy and red when cold/crying
-milk jaundice after 24 hours
Normal nb temp?
36.5-37.5 axillary temp
Normal nb feeding?
After 24 hours 8 -12 times per day (every 2-4 hours)
-minimum 20 mins (though more is common)
-may cluster feed, then not feed for a stretch
Normal nb output?
Day 1 = 1 wet diaper
Day 2 = 2 wet diapers
Day 3 = 3 wer diapers
Stools black-greenish sticky for first few days, then seedy yellow milk poos starting day 3-5 (unless they are on formula)
6-8 diapers a day and 2 or more stools
What is TTN?(5)
Transient Tachypnea of the Newborn is transient condition with delayed removal of fluid from lungs. Usually short lived and benign.
* Grunting
* higher resp rates
* nasal flaring
* effort to breath
* retractions
