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Natural Childbirth I > Final > Flashcards

Final Flashcards

1
Q

Labor - Definition (long)

A
  • Sequential, integrated set of changes with the myometrium, decidua, and uterine cervix that occur gradually over a period of days to weeks
  • Change in myometrial contractility pattern from “contractures,” a pattern of long-lasting low-frequency activity, to “contractions,” high-intensity high-frequency activity resulting in effacement and dilation of the uterine cervix
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2
Q

Labor - Definition (short)

A
  • Clinical diagnosis
  • Regular uterine contractions
  • Progressive cervical effacement
  • Progressive uterine dilation
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3
Q

“False” Labor - Definition

A
  • Regular uterine contractions

- No change in cervical dilation

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4
Q

Term Pregnancy - Definition

A
  • 37 - 42 weeks
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5
Q

Onset of Labor - Hormones/factors Involved in Parturitional Cascade

A
  • Prostaglandins
    > Increased prostaglandins, especially PGE2 and PGF2, near initiation of labor soften cervix and can help cause contractions
  • Progesterone
    > Progesterone withdrawal does not occur in all women before labor
  • Estrogen
    > Up-regulates receptors on uterus, increasing contractility
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6
Q

Onset of Labor - Oxytocin

A
  • Synthesized in the hypothalamus and released from the posterior pituitary
  • Stimulates uterine contractions
  • Circulating levels of oxytocin do not change significantly during pregnancy or prior to the onset of labor
  • Uterine myometrial receptors become increasingly sensitized to oxytocin during the second half of pregnancy
  • Unlikely to stimulate labor, but definitely makes stronger uterine contractions
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7
Q

Onset of Labor - Role of the Fetus

A
  • Not well understood

- Potentially controls the timing and onset of labor, possibly due to increased fetal pituitary-adrenal activity

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8
Q

First Stage of Labor - Definition

A
  • Interval between the onset of labor and full cervical dilation (10cm)
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9
Q

First Stage of Labor - Latent Phase

A
  • Characterized by slow dilation
  • Period between onset of labor and point at which the rate of cervical dilation increases **(up to 4cm dilation)
  • *- Contractions often 5-10 minutes apart, lasting 30-45 seconds
  • AKA: “early labor” or “prodromal labor”
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10
Q

First Stage of Labor - Active Phase

A
  • Characterized by a faster rate of dilation
  • *- Usually begins by 4cm dilation
  • *- Contractions often 2-4 minutes apart, lasting 60 seconds, more intense
  • “active labor”
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11
Q

First Stage of Labor - Transition

A
  • Characterized by a mix of cervical dilation and descent of fetus
  • *- 7-10cm
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12
Q

Second Stage of Labor - Definition

A
  • Characterized by the descent of the fetus through the maternal pelvis
  • *- Interval between full cervical dilation (10cm) and delivery of infant
  • There is usually a maternal desire to bear down with contractions and a sensation of pressure on the rectum
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13
Q

Management of Normal L&D - Onset of Labor

A
  • Regular firm contractions
  • Bloody show
  • Spontaneous rupture of membranes
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14
Q

First Stage Initial Evaluation

A
  • Establish baseline cervical status
  • Review prenatal record for medical conditions
  • Check for development for new disorders
  • Evaluate fetal status
  • Vitals
    > BP
    > Pulse
    > Temperature
  • Fetal heart rate
  • Frequency, duration, and strength of contractions
  • Cervical examination (may defer if the membranes are ruptured)
    > Dilation of cervix (0-10cm)
    > Effacement of cervix (0-100%)
    > Status of fetal head (-5cm - +5cm)
    > Status of amniotic membranes/presence of meconium
    > Presentation and position of fetus
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15
Q

Monitoring During Labor

A
  • Vitals every 4 hours (1-2 hours if abnormal)
  • Assessment of uterine contractions
  • Cervical examinations
    > On admission
    > 1-4 hour intervals during first stage
    > 1 hour intervals during second stage
    > When patient feels urge to push
    > With any fetal heart rate abnormalities
  • Fetal heart rate
    > Not mandatory for low-risk
    > Every 15 - 60 minutes during first stage
    > Every 5 minutes during second stage
    > Listen during and after contractions
    > Normal range is 110 - 160bpm
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16
Q

Activities During Labor

A
  • Food and drink should not be limited during labor for low-risk patients
    > Suggest juices, popsicles, broth, yogurt, crackers, fruit
  • Encourage patient to empty their bladder frequently
  • Give patient information
  • Give patient privacy
  • Factors associated with a satisfactory birth
    > Personal expectations met
    > Caregiver support
    > Participation in decision making
  • Coaching
    > Involve partner
    > Soothing, calm tone of voice
    > Give her visual images
    > Acknowledge what she is experiencing
    > Remind her that it will end and there will be breaks
    > Give her positive feedback
  • Encourage patient to change positions fequently
    > Standing, sitting, side-lying, squatting, hands-and-knees, kneeling
  • Pain relief/comfort measures
    > Position changes
    > Massage
    > Counter-pressure
    > Warm water
    > Encouragement
    > Homeopathy
    > Emotional support
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17
Q

Labor Augmentation

A
  • Hydration (oral or IV)
  • Calories
  • Position changes
  • Acupuncture
  • Homeopathy
  • Herbs
  • Breast pump
  • Amniotomy
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18
Q

Second Stage of Labor - Details

A
  • Push at either 10cm or when patient has urge to push
  • Can use valsalva or physiologic (however patient wants) positions to push
  • Length of second stage
    > Primiparous average around 2 hours, but can push longer if there’s progress and no distress
    > Multiparous average 1 hour or less
  • Episiotomy (unnecessary in normal births) indications:
    > Fetal distress at +4 station
    > Prolonged crowning
    > Need for instrumentation
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19
Q

Delivery - Steps in Assisting Birth

A
  • Patient pushes to crowning
  • Encourage patient to pant or give little pushes at crowning to stretch the perineum
  • One hand on vertex of fetal head to keep head flexed
    > Possibly apply counter-pressure
  • Other hand supports the perineum
  • After head is delivered, allow for spontaneous restitution
    > Restitution = baby’s rotational position changing to help deliver shoulders AP in pelvis
    **- Reduce nuchal cord (cord around baby’s neck), if present
  • With next contraction, apply gentle downward traction toward the maternal sacrum to deliver the anterior shoulder
  • As soon as the anterior shoulder becomes visible, deliver the posterior shoulder with upward traction
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20
Q

Third Stage of Labor - Definition

A
  • Interval between fetal delivery and complete expulsion of the placenta
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21
Q

Third Stage of Labor - Length

A
  • Risk of postpartum hemorrhage (PPH) increases with length of third stage
  • Lengths
    > Average length is 5-6 minutes
    > 90% by 15 minutes
    > 97% within 30 minutes
  • Gestational age is the major factor influencing the length of the third stage
    > Pre-term deliveries are associated with a longer third stage
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22
Q

Third Stage of Labor - Cord Clamping

A
  • Often done by a family member
  • 75% of placental blood is transferred to infant in the first minute
  • Benefits of delayed cord clamping
    > Higher hemoglobin levels
    > Lower rates of anemia in ages 2-6 months
    > Important for babies whose mothers have low ferritin
    > Important for babies who will be breastfed without iron supplementation
    > Important for low birth weight babies
    > Lower risk for necrotizing enterocolitis
    > Less intraventricular hemorrhage
  • Disadvantages of delayed cord clamping
    > Higher rate of polycythemia
    > Greater need for phototherapy for term infants with jaundice
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23
Q

Third Stage of Labor - Cord Milking

A
  • Alternative to delayed clamping
  • Might help stabilize BP and increase urinary output in preemies
  • Milking the cord 4x roughly equals 30 seconds of delayed clamping
    > Similar benefits and disadvantages
  • Should not delay delivery or treatment in order to milk the cord
  • Should not milk the cord if planning to collect cord blood
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24
Q

Third Stage of Labor - Cord Blood

A
  • For diagnostic purposes
    > Allow blood to drain from the cut end into a glass tube prior to delivery of the placenta
    > May be screened for type and Rh, as well as any necessary newborn conditions
    > Not used for pH testing (collect for that using needle into umbilical artery)
  • For banking purposes
    > Can be done with placenta in utero or ex utero
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25
Q

Third Stage of Labor - Placental Delivery

A

**- Signs of placental shearing
**> Gush of blood
**> Umbilical cord lengthening
**> Uterus becomes firmer and globular
**> Uterus moves upward
- Placental expulsion
> Spontaneous uterine contractions and patient bearing down
> Expectant management
^ Follows natural physiology
^ Usually involves delayed cord clamping
^ Monitor patient’s vitals, bleeding, and for signs of placental shearing
^ Placenta will be expelled naturally
> Active management
^ Typically does not shorten third stage, but does lessen blood loss
^ Early cord clamping, cord traction, and prophylactic oxytocics
- Technique
> When tractioning the cord, prevent uterine prolapse by guarding the uterus
> Immediate nursing and/or nipple stimulation does not prevent PPH or significantly decrease blood loss
> Excessively massaging the uterus could negatively impact placental shearing and contribute to PPH
> Patient in upright position will help placental expulsion
**- Retained placenta
**> Herbal angelica
**> Homeopathic pulsatilla or sabina
- After normal delivery of placenta
> Check for firm uterus every 5-10 minutes to control bleeding
> Fundus should feel hard and be near the level of the umbilicus
> 1 cup of fluids every hour patient is awake
> Stay in bed for 2 days minimum except to use the bathroom
> Can shower after 12 hours if no dizziness or hemorrhaging

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26
Q

Third Stage of Labor - Blood Loss

A

**- Normal is 250-500mL
**- PPH is 500mL or more
- Etiologies
> Uterine atony - 80%
> Episiotomy
> Lacerations
> Placenta accrete (Emergency! - placenta implanted in myometrium)
- Risk factors
> Severe anemia
> Grand multiparity
> Hx of PPH in patient or family
> Low-lying placental implantation
> Placental abruption
> Precipitous labor
> Prolonged labor
> Chorioamniotitis
> Uterine fibroids
> Overdistended uterus
> Oxytocin use
> Mismanaged or prolonged third stage
- 4% of all births
- Signs and symptoms
> Rising fundus
> Vaginal bleeding
*> Tachycardia precedes BP drop
> Shock
- Sequelae
> Sheehan’s syndrome
> Breastfeeding difficulties
> Postpartum endometritis
- Treatment
> IM or IV oxytocics
**> Uterine massage or bimanual pressure
> IV
> Homeopathy (after patient is stable)
^ Belladonna
^ Lachesis
^ Sabina
^ China
^ Phosphorus
> Herbal remedies
^ Cinnamon (30 ggts immediately)
^ Collonsonia (after stable)
^ Shepherd’s purse (after stable)
^ Bayberry (after stable)

27
Q

Third Stage of Labor - Cord

A
  • Normally 2 arteries and 1 vein inserted into the center of the placenta
  • Average 55cm long and 2cm thick
  • Abnormal cord variations
    > Length (long or short have different risks)
    > Vessels (most common congenital anomaly is 1 artery and 1 vein - 1% of infants)
    > Cord insertion (Battledore/Marginal - within 1.5cm of placental margin; vellamentous insertion - vessels travel through membranes before joining the cord)
28
Q

Tips for Emergency Delivery

A
  • Be calm and reassuring
  • Keep everything as clean as possible - wash hands, use clean towels
  • Use counter-pressure to slow the delivery of the head; encourage patient to pant to slow delivery
  • Check for nuchal cord once head is delivered
    > Fix it if it’s there
  • Ensure restitution happens
  • Deliver carefully because slippery; will likely come out on its own after shoulders
  • Dry baby and wrap it (including head) to keep it warm
    > Prevents respiratory depression
  • If baby isn’t breathing, rub vigorously along spine; acupressure K1 (bottom of foot)
  • Deliver placenta if unavoidable or patient is bleeding; fine to wait if stable
    > If delivered, keep for later observation
  • After delivering placenta, massage uterus to keep uterus firm and minimize blood loss
  • Don’t clamp and cut the cord until you have sterile instruments
29
Q

Abnormal L&D - Prolonged Labor - Failure to Progress

A 
- Risk factors
     > Patient pelvis issues
     > Inadequate uterine contractions
     > Poorly flexed fetal head
     > Emotional dystocia
30
Q

Abnormal L&D - Prolonged Labor - Prolonged Latent Phase

A 
- Associated with complications and less-successful labor (patient and uterus get tired)
     > Fever
     > Fetal distress
     > C-section
     > Neonatal resuscitation
     > Thick meconium
     > Increased NICU admissions
     > Increased risk for PPH
- Management
     > Decrease stress
     > Rest
     > Distraction
31
Q

Abnormal L&D - Prolonged Labor - Other Issues

A
  • Cephalopelvic disproportion (CPD)
    > Head and pelvis don’t fit together
  • Deep Transverse Arrest
    > Vertex in right or left occiput transverse position
    > More common in platypelloid or android pelvis
  • Persistent asynclitism
    > Baby positioned asymmetrically
32
Q

Abnormal L&D - Management of Prolonged Labor

A
  • Position changes
  • Epidural
  • Anticipatory management (instrument delivery; c-section)
  • Homeopathy
  • Comfort and support
  • Herbs to increase uterine activity
    > Blue cohosh
    > Black cohosh
    > Raspberry
    > Mitchella
    > Mistletoe
  • Chinese medicine
    > Shiatsu
    > Acupuncture/acupressure
33
Q

Abnormal L&D - Second Stage

A 
- Shoulder dystocia
     > Anterior shoulder trapped behind pubic bone (flip patient to hands and knees)
     > Increased time between delivering the head and the body
     > Predisposing factors
          ^ Macrosomia
          ^ Abnormal pelvis
          ^ Excessive weight gain during pregnancy
          ^ Gestational diabetes
          ^ Increasing parity
          ^ Induction of labor
          ^ Post-term pregnancy
          ^ Short stature
          ^ Vacuum or forceps-assisted birth
     > Fetal complications
          ^ Fractured clavicle or humerus
          ^ Brachial plexus injury
          ^ Asphyxia with neurological damage
          ^ Death
     > Maternal complications
          ^ Bladder injury
          ^ 4th degree laceration
          ^ PPH
- Cord issues
     > Cord prolapse
34
Q

Abnormal L&D - Malpresentations

A 
- Breech
     > Prevention - encourage rotation during pregnancy
          ^ Homeopathy
          ^ Chinese medicine
          ^ External cephalic version
          ^ Slantboard
     > Risks
          ^ Cord prolapse
          ^ Head entrapment
          ^ Abdominal organ damage
- Shoulder presentation
     > Cannot deliver
     > Either rotate or c-section
- Brow presentation
     > C-section required (cannot deliver without flexion of head)
- Face presentation
     > Usually related to short cord
- Persistent occiput posterior
     > Causes complications from premature urge to push
          ^ Cervical laceration
          ^ Patient exhaustion
          ^ Fetal exhaustion/distress
          ^ Cervical edema
     > Management
          ^ Positions to shift occiput off sacrum
          ^ Facilitation of rotation
          ^ Comfort measures
35
Q

Abnormal L&D - Preterm Labor

A

** - Labor between 20-37 weeks gestation
- 10% of all deliveries in US
- Risk factors
> <18 or >40 yo
> Low socioeconomic status
> Physically demanding job
> Past history of preterm birth
> BMI < 19.8
> Uterine conditions
> Premature rupture of membranes (PROM)
> Placenta previa
> Placental abruption
> IUGR
> Preeclampsia
- Diagnosis
> Increase in uterine activity
> Cervical changes (effacement/dilation)
> TVUS for cervical length
> Fetal fibronectin
> Identify and treat infections

36
Q

Abnormal L&D - Meconium Aspiration

A
  • Can be a sign of maturation, not fetal distress
  • In early labor, can be associated with lower Apgar scores, meconium aspiration syndrome, fetal ischemia, and chorioamnioitis
  • Management
    > Exclude breech
    > Patient left-side lying with IV and O2
    > Monitor patient’s temperature every 2 hours
    > Internal fetal monitoring
    > Amnioinfusion
    > Be prepared to resuscitate newborn
37
Q

Breastfeeding - General

A

**- Human milk is recommended as the exclusive nutrient for term infants for the first 6 months, then in conjunction with solids for the next 6 months, and then continued for as long as is beneficial for parent and baby

38
Q

**Breastfeeding - Physiological Preparation/Details

A
  • First trimester
    > Breast glandular tissue development and growth stimulated by hCG, progesterone, and *prolactin
  • Second and third trimesters
    > Lobule formation and enlargement
    > Secretion begins
    > Colostrum formed
  • Labor and lactation
    > Further growth and differentiation of lobule
    > Colostrum secretion
    > Secretion is activated
    ^ By a drop in progesterone after placental delivery
    ^ By the presence of prolactin and cortisol
    ^ Occurs 2-3 days postpartum
    ^ Maintenance of lactation require regular removal of milk and nipple stimulation
  • Regulation of milk production
    > Prolactin
    > Breast emptying leads to increased milk volume by 5-15%
    > Distention of mammary glands decreases milk production
  • Milk ejection
    > Tactile stimulation of the nipple leads to oxytocin release
    > Oxytocin causes contraction of the mammary glands, pushing milk into the ducts and out through the nipple
39
Q

**Breastfeeding - Colostrum

A
  • Produced during second half of pregnancy
  • Present for first 2 days after birth
  • Thick yellow consistency
  • Low volume, low in calories and fat
  • *- High in minerals, protein, fat-soluble vitamins, and antibodies
  • *- Helps establish gut flora
  • *- Has laxative effects
40
Q

Breastfeeding - Breast Milk

A
  • Generally comes in 2.5 - 3.5 days after birth
  • Increased volume compared to colostrum
  • Has proteins (80% whey), lipids, and carbs
  • Highly bioavailable iron, and other minerals
  • Beneficial flora
  • Antibodies
41
Q

Breastfeeding - Functions of Breast Milk

A
  • Immune modulating
  • Anti-inflammatory
  • Aids in digestion
  • Promotes growth of crypt cells in intestinal tract
42
Q

**Breastfeeding - Long-Term Benefits for Infants

A
  • Fewer acute illnesses
  • Reduced incidence of obesity
  • Reduced incidence of cancer
  • Decrease in cardiovascular risk factors
  • Decreased risk of type 1 diabetes
43
Q

**Breastfeeding - Benefits for Parent

A
  • Quicker recovery from childbirth
  • Reduction of stress response
  • Postpartum weight loss
  • Prolonged postpartum anovulation
  • Reduced risk of breast and ovarian cancer
  • Decreased risk of cardiovascular disease and obesity
44
Q

*Breastfeeding - Initiation

A

**- Should be initiated within first hour after birth
**- Positioning
> Belly to belly
> Baby mouth aligned with nipple
> Neck slightly extended
> Ear, shoulder, and hips are in alignment
- Latch-on
> Form a tight seal with mouth around nipple and areola
**> Infant mouth wide open with lips splayed
- Milk transfer
**> Baby tongue squishes nipple to cause milk ejection
> Efficient transfer depends on coordination of suck/swallow
**> Tongue-tie affects eating, and eventually talking
^ SSx = reflux, spitting up, discomfort in car seat and lying on back

45
Q

Breastfeeding - Timing of Feeding

A
  • Feedings initiated by demand
  • Offer both breasts each time, and try to empty them
  • Average number of feedings is 8-12/24 hrs, 10-15 minutes/breast
46
Q

Breastfeeding - Assessment of Intake

A
  • Normal to lose up to 10% of body weight initially; should be back to birth weight by 2 weeks of age
    *- Baby who wants to nurse all the time isn’t getting enough
    *> Might be sign of heart of liver disease
  • Urine output
    > 1 pee in first day
    > 2-3 in day 2
    > 4-6 in days 3-4
    > 6-8 per day after day 4
  • Stool output
    > Meconium is tarry black lining of intestinal tract passed in first 3 days
    > Transitional stool present by day 3
    > Breastmilk stool present by day 5, 3x/day
47
Q

Breastfeeding - Excessive Weight Loss

A
  • Assess if >7% weight loss
  • Reasons
    *> Inadequate milk production
    ^ Tubular breasts
    ^ Delay in production
    ^ Parental medications
    ^ Previous breast surgery
    *> Poor milk transfer
    ^ Infrequent feeding
    ^ Poor latch
    ^ Use of formula
    ^ Oral-motor or neurologic abnormalities
    > Disease of newborn
    ^ Cardiac abnormalities
    ^ Kidney abnormalities
    ^ Gastrointestinal abnormalities
    ^ Newborn metabolic diseases
48
Q

Breastfeeding - Excessive Weight Loss/Inadequate Weight Gain - Management

A
  • Review histories, assess intake/output
  • Encourage frequent and full feedings
    > Put to each breast every 2-3 hours for 10-15 minutes each; keep baby awake while feeding
  • Follow breastfeeding with 10 minutes of pumping to feed later
  • Optimize parental milk production ability
    > Sleep, water, calories, stress, confidence
  • Galactogogue herbs
    > Trigonella
    > Foeniculum
    > Cnicus
    > Galega
    > Medicago
  • Galactogogue medications
    > Domperidone (Motilin)
    ^ Okay for long-term use
    ^ 10-30mg TID
    ^ Increases prolactin
    > Metoclopramide (Reglan)
    ^ 7-10 days only
    ^ 10-15mg TID
    ^ Increases prolactin
  • Daily logs of weight, intake, output
  • Supplement with pumped milk, donor milk, or formula
49
Q

Nipple and Breast Pain - Causes and Evaluation

A 
- Causes
     > Engorgement
     > Nipple injury
     > Plugged ducts
     > Nipple vasoconstriction
     > Nipple/breast infection
- Evaluation
     > History
     > Physical examination of parent, infant, and feeding
50
Q

Nipple Pain

A
  • Normal to have sensitivy in first week, should subside within first minute of feeding
  • Nipple injury
    **> Pain lasts throughout feeding and past first week
    > Exam for scabs, cracks, and/or blisters
  • Management
    • > Correct the latch (every time it’s bad)
      Let the nipples air dry
      Nurse on unaffected side first
      Cool or warm compresses
      Apply expressed breast milk to nipples
      Apply lanolin or nipple butter to nipples
      Consider frenotomy if ankyloglossia present
  • If nipple pain is refractory to conservative measures
    > Consider using a nipple shield temporarily
    > Consider an infectious source
    ^ Tx with APNO (all-purpose nipple ointment)
    ^ Try thrush treatments
    > Consider areolar eczema
    **> Consider nipple vasoconstriction
    ^ Possible history of Raynaud’s
    ^ Nipple shows pallor, then cyanosis, then erythema
    ^ Burning pain with nursing, and possibly with cold exposure
    ^ Treatments
    ) Warm nipple before nursing
    ) Avoid caffeine and nicotine
    ) Magnesium
    ) Nifedipine (Ca-channel blocker)
51
Q

Breast Pain - Engorgement

A
  • Accumulated breast milk that causes breast to firm up and be painful
  • Can inhibit latch
  • Can happen as milk comes in, or if wait too long between feedings
  • Management
    > Remove milk from breasts
    > Warm compresses or shower before feeding
    > Cold compresses between feedings
    > Cabbage leaves
    > Cold gel packs
    > Acupuncture
52
Q

Breast Pain - Plugged Ducts

A
  • Painful lump in breast tissue
  • Localized areas of milk stasis
  • Risk factors
    > Poor feeding technique
    > Ill-fitting bra
    > Abrupt decrease in feeding
  • Management
    > Improve latch
    > Aim chin towards affected area
    > Completely drain the breast
    > Warm compresses
    > Manual massage
    > Homeopathy
    > Open the milk blebs with a sterile needle
53
Q

**Breast Pain - Mastitis

A
  • Local inflammation of the breast associated with fever, muscle pain, breast pain, and erythema
  • Likely infectious
  • Most common in first 6 weeks postpartum
  • Symptoms
    > Indurated, erythematous, tender area of breast
    > Elevated parental temperature
  • Risk factors
    > Nipple trauma
    > Infrequent feedings
    > Inefficient milk removal
    > Parental illness
    > Milk oversupply
    > Rapid weaning
    > Pressure on breast
    > Blocked milk duct
    • > Parental stress, fatigue, or malnutrition
  • Treatment
    > Improve feeding technique
    > Completely empty breasts
    > Nurse on affected side first
    > Increase frequency of feedings
    > Alternating hot and cold compresses; ginger compress
    > Rest
    > Adequate food and water
    > Homeopathy
    ^ Phytolacca
    ^ Belladonna
    ^ Bryonia
    > Herbs
    ^ Combo products (like Bioveg)
    ^ Echinacea
    ^ Oregon grape
    ^ Phytolacca
    ^ Myrrh
    ^ Garlic
    ^ Topical ginger or phytolacca oil
    ^ AVOID hydrastis - decreases milk supply
    > Antibiotics
    ^ Dicloxacillin 500mg QID
    ^ Cephalexin 500mg QID
    ^ Clindamycin 300mg QID
    ^ IV antibiotics if severe
  • Treatment should be effective in 48-72 hours
54
Q

**Breast Pain - Thrush

A
  • Diagnosed clinically
  • Symptoms
    > Burning of the nipple
    > Severe deep shooting or stabbing pain towards the breast wall
    > Symptoms out of proportion to physical findings
    > Shiny or flaking skin on affected nipple
    > May see infant oral thrush or diaper candida
  • Parental treatments
    > Topical antifungals (nystatin less effective)
    > 1% gentian violet in water applied to baby’s mouth before feeding, 3-4x/day
    > 1 Tbsp vinegar in 1 Cup water to rinse breast
    > Grapefruit seed extract
    > Probiotics
  • Infant treatments
    > Gentian violet
    > Probiotics
    > Nystatin oral suspension
55
Q

Weaning

A
  • Recommended to breastfeed at least one year
  • Strategies to wean
    > Drop a session every 2-5 days
    > Shorten each session
    > Introduce bottle or cup feedings
56
Q

Formula Feeding

A
  • Cow’s milk
  • Soy milk
  • Partial whey hydrosylate formulas
  • Extensive casein or whey hydrosylate formulas
  • Amino acid based
57
Q

Infertility - Definition and Evaluation

A
  • No conception after one year of unprotected intercourse
  • Professional advice should be sought after 6 months
    > Female-bodied partner over 35
    > Irregular or absent menstrual periods
    > 2 or more miscarriages
    > Hx of tubal disease or pelvic infection
    > Hx or current prostate infection
    > Endometriosis
    > PCOS ssx
  • Evaluation
    > Sperm? Egg? Uniting issue? Implantation issue?
    > Primary infertility = never conceived
    > Secondary infertility = previous pregnancy
58
Q

Infertility Etiologies - Female

A 
- Ovarian issues
     > Anovulation
     > Oligoovulation
     > Oocyte aging
- Fallopian tube abnormalities/pelvic adhesions
     > PID
     > Endometriosis
     > Previous surgeries
     > Inflammatory bowel disease
- Luteal phase defects (most common)
- Others
59
Q

Infertility Etiologies - Male

A
  • Varicocele
  • Hydrocele
  • Defective ejaculation
  • Trauma
  • Torsion
  • Testicular cancer
  • Hormonal issues
60
Q

Infertility - Lifestyle Factors

A
  • Lubricants that impair sperm motility (KY, Astroglide, olive oil, saliva)
  • Tobacco use
  • BMI in female
  • Exercise helps or decreases depending on BMI and type/length of exercise in female
  • Heavy alcohol use
  • Diet - mixed results, Mediterranean Diet might be good
  • Stress
  • Environmental toxins
    > BPA
    > Lead
    > Mercury
61
Q

Infertility - Diagnosis

A
  • Hx and PE
  • Semen analysis
  • Drug and medication eval
  • LH, FSH, TSH, CBC, Prolactin, T
62
Q

Infertility - Male Treatment

A
  • Vitamin C
  • Beta-carotene
  • Vitamin E
  • Zinc
  • Copper
  • Herbs
    > Panax ginseng
    > Avena sativa
    > Saw palmetto
    > Hops
63
Q

Infertility - Female Treatment

A 
- Hormone imbalance (anovulation)
     > Vitex
     > Vit E
     > B complex
     > Zinc
- Decreased ovarian function
     > True unicorn root
     > Beta-carotene
- Hormonal imbalance (decreased estrogen)
     > Licorice
     > Fennel
     > Alfalfa
     > True unicorn root
     > Burdock
- Hormonal imbalance (decreased progesterone)
     > Wild yam
     > Vitex
     > Sarsaparilla
     > Lipotropic
     > Progesterone
- General tx
     > Caullophyllum
     > Pulsatilla (herb)
     > Black haw
- Fertility drugs for ovulation induction
     **> Clomid (NOT used in women w/ low estrogen (older than 40ish)

Natural Childbirth I (2 decks)

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