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Natural Childbirth > Final > Flashcards

Final Flashcards

1
Q

definition of infertility

A

No conception after 1 year of unprotected intercourse

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2
Q

Professional advice should be sought after 6 months if any of the following factors are present

A
  • Female partner over age 35
  • Irregular or absent menstrual periods
  • 2 or more miscarriages
  • Prior history of tubal disease or pelvic infection
  • History or current infection of the prostate
  • Reversal of surgical sterilization of either partner
  • Endometriosis
  • Breast discharge
  • Excessive acne or hirsutism
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3
Q

basic causes of infertility for females

A 
Ovarian issues (oligoovulation, anovulation, oocyte aging)
Fallopian tube abnormalities/pelvic adhesions (PID, endometriosis, previous surgeries, IBD)
Uterine issues (reduced implantation, leiomyomas)
Luteal phase defects (abnormalities of corpus luteum causing inadequate progesterone) 
Cervical factors (cervical mucus, stenosis)
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4
Q

basic causes of infertility for males

A 
varicocele
hydrocele
defective ejaculation
cryptochordism
antisperm antibodies
infection
hormonal issues
congenital disorders and chromosomal
testicular cancer
trauma
torsion
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5
Q

Testing for infertility

A

semen analysis
menstrual hx
LH surge assessment in urine and/or luteal phase progesterone
Day 3 Serum FSH and estradiol levels

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6
Q

Naturopathic treatments for infertility (males)

A

Supplements: Vit C (1-5 qd), Vit E (400 IU qd)
Botanicals: ginseng (5-30 gtts BID), oats (15-30 gtts TID)

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7
Q

Naturopathic treatments for infertility (females)

A

Vitex angus castus with aletris, cimicifuga (1/2 tsp BID)

Supplements: Vit E (400 IU QID), Zn (50 mg QID)

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8
Q

Labor

A

regular uterine contraction
progressive cervical effacement
progressive uterine dilation

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9
Q

term pregnancy

A

37-42 weeks

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10
Q

what stimulates contractions?

A

oxytocin (oxytocin levels don’t increase but rather receptors become more sensitive)

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11
Q

Hormones/factors involved in the parturitional cascade (during onset of labor)

A

Prostaglandins: increased to soften cervix and help contractions
Progesterone: withdrawal (doesn’t always occur)
Estrogen: up regulates receptors in uterus increasing contractility

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12
Q

Fetal secretions of what starts the cascade?

A

Cortisol appears to increase placental CRH, CRH enhances prostaglandins and potentiates the effects of oxytocin

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13
Q

First stage of labor

A

interval between the onset of labor and full cervical dilation

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14
Q

full cervical dilation

A

10 cm

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15
Q

the 3 phases under first stage?

A
  • Latent phase: slow dilation, contraction are 5-10 min apart, lasting 30-45 sec
  • Active phase: faster rate of dilation, begins at 4 cm dilation, contraction often 2-4 min apart, lasting 60 seconds
  • Transition phase: begins at 7cm, characterized by a mix of dilation and descent of fetus
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16
Q

Second stage of labor

A

refers to the interval between full cervical dilation and delivery of infant
this is where the maternal desire to bear down (push) with contractions usu starts

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17
Q

what are the cardinal movements?

A

flexion and descent
internal rotation
extension of head
restitution once head is free (external rotation)
delivery of ant. shoulder, then posterior shoulder

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18
Q

3 P’s of labor

A

power (strength of uterine contractions)
passenger (refers to fetus)
pelvis

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19
Q

what indicates onset of labor?

A

regular firm contractions
bloody show (cervical changes)
spontaneous rupture of membranes (rupture of amniotic sac)

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20
Q

Initial examination

A 
dilation of cervix (0-10 cm)
effacement of cervix (0-100%)
station of fetal head (-5 to +5)
status of amniotic membranes/presence of meconium
presentation and position of fetus
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21
Q

widest part of head to deliver through narrows part of pelvis?

A

biparietal diameter through the ischial spines of pelvis

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22
Q

monitoring during labor

A

vital every 4 hrs if normal (1-2 hrs with abnormalities)
assessment of uterine contractions
cervical examinations
fetal heart rate (every 15-60 min during first stage, every 5 min during second stage, listen during and after contractions, normal range is 110-160 bpm)

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23
Q

what activity should you encourage in a woman during labor?

A

empty their bladders regularly

change positions frequently (every 1-2 hrs)

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24
Q

what are some easy pain relief measures?

A

position changes
massage
warm water
homeopathy

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25
Q

what can you do to augment labor (make it stronger)

A 
hydration
calories (sugar, protein and fat)
acupuncture
herbs (black cohosh, mistle toe)
breast pump
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26
Q

what is amniotomy and why might you do it?

A

artificial rupture of membranes

to encourage labor

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27
Q

positions for pushing in second stage?

A

follow mom’s lead

consider squatting, hands and knees, sitting in tub

28
Q

pushing techniques

A

valsalva - pull back knees, tuck in chin, take a deep breath and hold it and push
physiologic - she pushes when she feels a need

29
Q

on avg how long does second stage last?

A

2 hrs (with multiparous 1 hr)

30
Q

Steps in assisting birth

A
  • Woman pushes to crowning
  • At crowning, coach her to pant or give little pushes to allow perineum to stretch
  • Place one hand on the vertex of the fetal head to keep head flexed. Can also apply some counter-pressure
  • After head is delivered, allow for spontaneous restitution
  • Reduce nuchal cord (umbilical cord around baby’s neck) if present
  • With next contraction, apply gentle downward traction toward the maternal sacrum to delivery the anterior shoulder
  • As soon as anterior shoulder becomes visible, deliver posterior shoulder with upward traction
31
Q

what stimulates breast tissue development during pregnancy?

A

hCG, progesteron and prlactin

32
Q

after delivery what leads to colostrum secretion?

A

drop in progesterone

presence of prolactin and cortisol

33
Q

what leads to milk ejection?

A

tactile stimulation of the nipple by infant leads to release of oxytocin (cause contraction of mammary glands, pushing milk into ducts and out through nipple)

34
Q

when is colostrum produced? what’s in the stuff?

A
  • present first 2 days of life
  • low in calories and fat
  • high in minerals, protein, fat-soluble vitamins, antibodies
35
Q

role of colostrum?

A

helps establish gut flora

laxative effects

36
Q

when does breastmilk come in? what’s in the stuff?

A
  • at 2 1/2 to 3 1/2 days
  • protein (whey and casein), lipids, carbs (lactose), minerals (bioavailable iron), beneficial flora and antibodies (IgA and IgG)
37
Q

role of breastmilk?

A
  • Bacteriostatic and immune modulating
  • Fewer infections of any kind in nursing infants
  • Anti-inflammatory
  • Aids in digestion
  • Promotes growth of crypt cells in the infant’s intestinal tract
38
Q

infant long-term benefits of breastfeeding?

A

decreases risk of obesity

decreases risk of type 1 diabetes

39
Q

maternal benefits to breastfeeding?

A

prolong postpartum anovulation
postpartum weight loss
accelerates recovery from childbirth

40
Q

how soon after deliver should breastfeeding be initiated?

A

within 1st hour

41
Q

breastfeeding positions

A

Baby belly to belly with mom
Baby’s mouth aligned with mom’s nipple
Neck slightly extended
Ear, shoulder, and hips are in alignment

cradle or cross cradle position or seated

42
Q

initiation of breastfeeding

A

latch-on: formation of a tight seal of the infant’s lips around the mother’s nipple and areola, infants mouth must be wide open
milk transfer: infant tongue elongates the nipple and compresses the ducts

43
Q

efficient transfer depends on coordination of which two actions?

A

suck/swallow

44
Q

when to feed?

A

demand feeding (in response to infant cues like licking, rooting, sucking and crying)
8-12 X per 24 hrs
10-15 min per breast

45
Q

weight loss/gain of infant

A
  • normal to lose up to 10% of body weight in first 5 days of life (due to colostrum)
  • should be back to birth weight by 2 weeks
  • avg gain thereafter is 15-40 g per day (1/2 to 1 1/2 oz daily)
46
Q

stool changes

A
  • meconium- black tarry lining of intestinal tract present at birth to first 3 days
  • transition stool- should be present by day 3
  • breast milk stool- orange/yellow and seedy, should be present by day 5, should see at least 3 per day
47
Q

normal nipple sensitivity

A

first week of breastfeeding, painful latch that should subside 1 minute into breastfeeding

48
Q

management of nipple pain

A

let nipples air dry
cool or warm compresses
apply expressed breast milk to nipples

49
Q

causes of breast pain and tx

A
  • engorgement- accumulation of breast milk that results in firmness of breast tissue (tx: completely drain breasts, compresses, cabbage leaves)
  • plugged ducts- localized areas of milk statis (tx: above plus manual massage, homeopathy)
  • mastitis- local inflammation of the breast assoc. with fever, muscle pain, breast pain and erythema (tx: improve breastfeeding technique, completely empty breasts, nurse on affected side first, increase frequency of feeding, hydrotherapy)
50
Q

specific homeopathy and herbal treatments for mastitis?

A
  • homeopathy- phytolacca, belladonna, bryonia

- herbs- biovegetarian, echinacea, topically apply ginger

51
Q

pharmaceuticals for mastitis?

A

antibiotics (dicloxacillin, cephalexin, climdamycin)

52
Q

breast abscess

A

localized collection of pus within the breast tissue (bigger than plugged duct)

53
Q

when to consider US?

A

for any mastitis refractive to treatment

increasing pain

54
Q

strategies for weaning

A

nurse until at least 1 year old
drop session every 2-5 days
shorten each breastfeeding session
introduce bottles, cup feedings

55
Q

types of formula

A
  • cow’s milk
  • soy
  • partial whey hydrolysate
  • extensive casein or whey hydrolysate
  • amino acid based
56
Q

what’s thirst stage?

A

the interval between fetal delivery and complete expulsion of the placenta

57
Q

Risk of Post partum hemorrhage (PPH) increases with?

A

length of third stage

58
Q

benefits to delayed cord clamping?

A
  • assoc. with higher hemoglobin levels
  • reduced the incidence of anemia in half
  • increase value to preterm infants
59
Q

disadvantages to delayed cord clamping?

A
  • contributes to a higher rate of polycythemia in neonates

- Greater incidence of phototherapy needed for jaundice in term infants

60
Q

what’s cord milking? what’s the benefit here?

A
  • the umbilical cord can be milked or stripped to enhance blood transfusion, would do this instead of delayed cord clamping
  • helps to stabilize bp and increase urinary output
  • higher hemoglobin levels
61
Q

normal placental separation

A

uterine muscle thickens following delivery of the infant reducing surface area and placental shearing takes place: upper area detaches last

62
Q

signs of placental shearing

A
  • gush of blood
  • umbilical cord lengthening
  • uterus becomes firmer and globular
  • uterus moves upward
63
Q

what could help mother with placental expulsion?

A

upright position

64
Q

what volume of blood is considered post partum hemorrhage (PPH)

A

blood loss of 500 ml or greater

65
Q

causes of PPH?

A
  • uterine atony
  • episiotomy
  • retained products of conception
  • maternal coagulation defects
66
Q

characteristics of cord

A

2 arteries, 1 vein
inserted into center of placenta
55 cm long

67
Q

emergency delivery

A

-Sterility: wash hands, and keep everything else as clean as possible.
-Slow delivery of head: give slight resistance to prevent head from just popping out. Ease it out. May need to tell mom to slow down. Panting to slow delivery
-Check for nuchal cord once the head is delivered
Get slack into cord and slip it over head if at all possible
-Deliver body carefully, they are slippery. Most babies come on their own after shoulders deliver.
-Dry them off and then wrap baby to keep it warm.
-If infant is not immediately breathing, rub the baby vigorously, along spine; and or acupressure to Kidney 1
-Deliver placenta if unavoidable or mother is bleeding, otherwise wait for help if she is stable: get it delivered and keep it for later observation.
-Massage uterus after placental delivery to decrease blood loss and keep uterus firm
-Don’t bother to clamp and cut the cord. It won’t hurt the baby, even if attached for hours. Better to wait for sterile instruments

Natural Childbirth (2 decks)

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