Kirsty Flashcards
What NIPE risk factors are there from Kirsty’s case?
- alcohol
- smoking
- PROM
- late booker
- club feet
- chlamydia
- medication
what key holistic points of Kirsty’s are there?
- 2nd degree tear
- fall at home
- anaemia
- mental health and bonding
- single mum
what would you advise Kirsty for analgesia for her tear?
I would ensure that Kirsty is taken the right dose and frequency of paracetamol which is 500mg-1g 4-6 hourly maximum of 4g. if so then due to her not being asthmatic she can have ibuprofen which is 200mg 1-2 doses three times a day to help with the pain. If nothing is working I would speak to medical staff who may increase Ibuprofen dose or prescribe another medication such as diclofenac. This is given P.O: 50mg T.D.S, P.R 100mg suppositories Once only. Caution as she was given labetalol in labour.
what is citalopram contraindications?
- baby is sleepy, reluctant to feed, heart detect.
- Although it’s passes into breastmilk in fairly small amounts, there may be another benefit.
- Potentially referral to GP to have this changed to another anti-depressant. Ask if they could review this.
what is the dose of iron taken daily?
- 210mg 1-2 per day
how does single mum impact holistic health and referral?
it is important not to stereotype these women, however, advise can be offered sensitively. Due to her age Kirsty should have a FNP who can help with social issues as well as midwives. Things that she can get help with is financial, such as citizen advise, local council, food banks, best start food vouchers. All this can take any financial anxieties away. This may help her physically as she is receiving additional money to buy health foods, any vitamins etc. this may help her mental health as this can reduce some anxieties. And her emotional health as well as she may feel well overwhelmed of become a mother of two and therefore cope better. Social aspect includes, most classes are free. However, this means that she can bond with her children and go to play groups or provide herself with some me time to socialise or chill.
how does her 2nd degree tear impact holistic health and referral?
may be tender which physically will be painful for Kirsty as she might struggle with some mobility issues. This may impact her mental health as she may feel as if she isn’t a competent mum if she can’t feel her best. Additionally, along with mental health this may make Kirsty feel emotional and overwhelmed due to post birth recovery and she may not realise how difficult it may be on her. This may cause her to be socially isolated she may not feel up to having family around or as able to go out. It is the midwife’s role to help Kirsty manage the perineum pain and provide her with advice around pelvic floor exercises, pain management and keeping clean. (plenty of clear fluids, warm water, avoid soap in that area).
how can a fall at home impact holistic health and referral?
which was very vague may indicate that Kirsty is perhaps not safe at home and there may some underlying concerns. The location of her bruising does not correlate with falling/ tripping but rather with things such as domestic abuse such as grabbing. However, it also states body which is quite vague as to whereabout. I would try and give Kirsty the opportunity to tell me by building a midwife-mother relationship. This is done by making the environment safe for her to disclose her feelings, non-judgemental and support her choices. I would give her the control of the situation as in if she does disclose I will ask for consent to discuss this with the multidisciplinary team, I would ask for consent to refer her to woman’s aid. And I would ask if she wanted my help, this gives her control over the situation and the choice which she won’t have in her relationship. The help I could provide is referrals to social work who can help her with housing if need be, financial support and with her mental health as well already poor, I would offer her perinatal mental health services. She can also decline to tell me and that’s her choice.
how does anaemia impact holistic health?
Kirsty had anaemia during her pregnancy which is known to make women exhausted, drained and short of breath. She was given iron tablets to manage this. After birth Kirsty had a 600 EBL which is a primary PPH. Therefore, due this Kirsty may feel higher levels of fatigue and overall, not be feeling 100%. Additionally, PPH is linked to low moods in the postpartum period therefore this is something to keep an eye on with Kirsty has she currently experiences. Therefore, watch for postpartum depression. This can also impact bonding and attachment which we can already potentially have a glimpse as baby Euan is in his cot. Additionally, due to being so tired this may impact her social health such as isolation as she is too tired to socialise.
how does anxiety and depression impact holistic health?
Kirsty has suffered from anxiety and depression during the antenatal period which makes her more likely to suffer from these in the postnatal period. Therefore, it is important that midwives monitor her mental health and try to limit/prevent the impacts this can have on Kirsty and Euan. Have a mental health problem postpartum can make bonding and attachment difficult. Midwives can promote this by doing skin-to-skin and keeping baby close to mum. Additionally, by supporting Kirsty breastfeed this can help with her bonding with baby Euan. Additionally, this can be an emotional time for Kirsty she may feel overwhelmed or anxious. This may then socially isolate her. Referral to perinatal mental health, increase appointments etc. health visitor.
how can smoking impact kirsty’s holistic health?
physically smoking is very damageable to mums but also baby’s in and out of utero. During this time, this is when mums and dad may be more open to changing and adjusting especially after the adjustment of being parents. Therefore, Kirsty may be more open to quitting. Therefore, referring her to smoking cessasion and quit your way Scotland who help you fin the first support. Smoking can negatively impact emotional health as it actually increases anxiety even though it is believed to do the opposite. Therefore, this may be beneficial to Kirsty and her mental health to stop. Social aspect is that previously if Kirsty had financial struggles then using that money to be cigarettes therefore limiting what she can experience with her kids that cost money. Now she has more money to do these things, to socialise more. Additionally, smoking can be seen as an opportunity to socialise and connect with other but on the other hand there is also a social stigma towards smokers therefore this eliminates this. Liaising with fnp is important as well as referring to third sector as the fnp may have contact with other services to help Kirsty more long term and have other support which I may not have access to.
How do we BEGIN support with a sleepy baby?
- Women centred approach demonstrated throughout (1)
- Observing and listening during conversations (1)
- Take history
- Discusses hands off approach (1)
- Clear relevant information shared (1)
- Mentions use of leaflets, analogies, props (1)
how do we support a sleepy baby?
- Lots of unhurried/uninterrupted skin contact to encourage milk hormones – oxytocin and prolactin.
- Encourage parents to look out for feeding cues and offer the breast at least 8/24hrs, help with positioning and attachment in these optimal times.
- Offer the breast using different feeding positions and alternate breasts. Remember biological ‘laid back’ feeding. Supporting parents with a sleepy baby – biological nurturing.
- Support with hand expressing – put this on baby’s upper lip to encourage, if unsuccessful store any colostrum collected.
- Lots of reassurance and support – it is important to inform mums that milk supply develops as the days progress and this early on it is normal to have minimal amounts.
- Assessing effective feeding -
- Look out for hypoglycaemia signs e.g. jittery and general observations to make sure baby is well.
how do we help with SKIN TO SKIN AND HORMONES?
- Explains the importance of stimulating oxytocin (1) – oxytocin is the hormone that ejects milk. It produces the ‘let down reflex’ which is controlled by the mother seeing, feeling, smelling her baby etc.
- Suggests things that will help with oxytocin:
- Having baby near (1)
- Gentle breast massage (1)
- Use of something to remind mother of baby (1)
How do we help with P+A?
- Baby held close (1)
- Baby held/supported with head and body inline (1)
- Baby’s head free to tilt back (1)
- Baby held with nose opposite nipple (1)
Attachment Points offered Achieved - Watch for baby to have a wide open mouth 1
- Mother moves her baby to her breast with head tilted back, chin leading (1)
- Bottom lip touches breast well away from the base of the nipple (1)
- Nipple aimed towards the rear of the roof of the baby’s mouth (1)
