Final Flashcards
Definition of infertility:
no PG in 1 year of unprotected intercourse
* seek tx after 6 mos of trying if over 35yrs, irreg menses, hirsutism, sterilization, prostate infx, 2+ miscarriages, endometriosis
Male fertility support - semen:
vit C
Avena sativa
ginseng
Male fertility support - testosterone:
saw palmetto
damiana
nux vomica (sm dose, short term)
3 parts of sperm analysis:
count
morphology
motility
What is Clomid (pharmaceutical)?
estrogen antagonist - not good for a woman 40+ yrs
2 herbs for ovulation:
vitex aletris farinose (true unicorn root)
also supplement beta carotene
3 herbs to support luteal phase for progesterone:
wild yam
vitex
smilax officinale (sarsaparilla)
supplement: oral micronized progesterone p.v. throughout 1st trimester
Naturopathic tx for infertility:
F: vitex, increased protein intake
M: saw palmetto, avena, Vit C, ginseng
What are mechanical infertility modes:
sperm motility/delivery issues impotence retrograde ejaculation F has sperm antibodies anatomical cervical issues endometriosis
How to deliver a baby in an emergent situation:
- counter pressure to keep head from popping out too fast
- flex head
- head will deliver, check for cord around neck (pull over)
- baby : moves : restitution
- shoulder comes out
- keep infant warm! dry off, skin to skin
- no crying: rub back, stimulate kidney-1 on feet, mouth to mouth
- keep cord - uterus rises in abdomen, cord gets longer
- deliver placenta - rub abdomen to push out clots
What amount is considered hemorrhage during labor?
over 500mL of blood
stop bleeding with Trendelenberg maneuver
When is the most important time to nurse?
the first hour - d/t hormones, adrenaline (baby is awake!) nurse 8-12x in a 24 hr period
3 advantages of colostrum:
high in minerals high in protein high fat soluble vitamins antibodies helps establish gut flora laxative effects
Advantages of breast feeding:
provides baby with antibodies
mom loses weight
keeps uterus contracting
nursing timing:
q 2 hrs, or 8-12x per 24 hours
2 functions of prolactin as it relates to nursing:
stimulates mammary glands to produce milk
causes enlargement of mammary glands
2 functions of oxytocin as it relates to nursing:
stimulated by infant suckling, helps let down milk
causes contraction of mammary glands
how is milk supply regulated in the body?
supply and demand
when it comes - enough for 2-3 babies
in a premie, milk makeup is different than full term
When does milk typically come in?
day 3
Formula options:
cows milk soy milk partial whey hydrolysate formulas extensive casein or whey hydrolysate formula amino acid based
How big is a neonate stomach?
size of an almond - don’t need to feed before mom’s milk arrives
Positions for breast feeding:
belly to belly
baby’s mouth aligned with nipple
neck slightly extended
ear, shoulder, and hip aligned
What do you do to support labor?
position changes massage counter pressure warm water encouragement
2 good positions for 2nd stage labor:
squatting
pull legs up
hands and knees
How long is an average labor?
12 hours
normal to have contractions on and off for 7 days, then 12 hours of active labor to delivery
Definition of labor:
contractions that increase in intensity that ultimately result in birth
Normal term is how many weeks?
37-42
Preterm - before 37 weeks
Physiology of starting labor:
Prostaglandins: increase, esp PGE2/PGF2 near initiation of labor
Estrogen: up regulates receptors on uterus, increasing contractility
First stage of labor:
latent, active, and transition phases
Onset to full cervical dilation
Latent phase:
* 0-4 cm
* slow dilation
* contractions 5-10 mins apart, 30-45 seconds
Active phase:
* faster rate of dilation
* 4-6 cm
* contractions 2-4 mins apart, 60 seconds
Transition phase
* 7-10 cm
* mix of cervical dilation and descent of fetus
Second stage of labor:
interval btw full cervical dilation and delivery
descent of fetus through pelvis
ends with delivery
Third stage:
delivery of placenta
avg 5-6 mins (90% by 15 mins, 97% by 30 mins)
What is restitution?
baby flips on side to get out of vaginal canal
anterior -> extends -> shoulder rotates
Do you help the baby during restitution?
No! you don’t know which way the baby wants to rotate. Don’t touch the baby while it’s turning.
Reasons you can’t get the baby out:
- contractions aren’t strong enough
- pelvis size / shape
- position (breech)
Amniotic fluid should be (color)?
clear
if green - meconium
After the water breaks, why can’t you put anything in the vagina?
risk of infx
Monitoring during labor:
vitals q 4 hours (normal) or 1-2 hours (abN) assessment of uterine contractions cervical examinations * on admission * 1-4 hr intervals during 1st stage * 1 hr intervals during 2nd stage * when pt feels urge to push * with any fetal HR abN
Pushing techniques:
Valsalva -
- pull back knees
- tuck chin
- deep breath and hold
- push!
Physiologic -
- follow mom’s lead
- she pushes when she feels the need
- tends to have shorter pushes without a closed glottis
Basic anatomy of breast tissue and ducts:
suspensory ligament fat glandular tissue duct pectoralis muscle
What is “tongue tied”?
short tongue due to attached frenulum mb assoc with folate deficiency * talking difficult * painful to nurse * easier to cut when very young
Mgmt of excessive baby wt loss with lactation (7+%):
reasons * inadequate milk production * poor milk transfer * disease of newborn encourage frequent and full feedings * baby to breast q 2-3 hrs for 10-15 mins each breast * stimulate sleepy babies to finish feeding Follow breastfeeding with 10 mins of pumping Feed baby any pumped milk Galactagogue herbs * trigonella * foeniculum
Breast pain - causes:
engorgement
nipple injury
plugged ducts
infection (staph, candida)
Breast pain - mgmt:
correct latch
let nipples air dry
cool or warm compresses
apply lanolin or nipple butter to nipples
consider frenotomy if ankyloglossia present
Mastitis can lead to:
abscess
tx with
* hepar sulph
* phytolacca oil topically
