Lactation and Puerperium Flashcards
In the post-partum period, what are the main physiological changes a woman will undergo?
- Uterus - involution
- Placental site re-epithelialises, uterus returns to pelvis
- Lochia (discharge) - rubra (red) to serosa (brown/yellow) to alba (white and mucusy)
- Blood
- Diuresis and resolution of oedema and expanded blood volume
- Resolution of anaemia
- Hypercoagulable state for 6 weeks post-birth - consideration of VTE prophylaxis
- Breast
- Hyperplasia and milk production
What are the main components of human milk?
- 4% fat, carbohydrates, proteins, minerals, growth factors, IgA
List some benefits of breastfeeding
- To baby: nutrition, less obesity, hypertension, higher IQ, lower SIDS, decreased hospitalisations and mortality from infections, decreased incidence of atopy
- To mother: return to pre-pregnancy weight faster, involution of uterus encouraged (less blood loss), reduction in breast/ovarian cancer, contraceptive effect
What are some contraindications to breastfeeding?
- Viruses e.g. HIV
- Drugs - antineoplastic agents, ergotamine, methotrexate, cyclosporine, radiopharm
What are some factors that encourage successful breastfeeding in the postpartum period?
- Antenatal education
- Early breastfeeding after delivery (1 hour)
- Encourage demand feeding and discourage formula feeds/dummies
- Encourage being in the same room
What is the hormonal trigger for stimulation of lactation postpartum? What about the ongoing maintenance hormones?
- Fall in progesterone post-partum
- Oxytocin and prolactin maintain (stimulated by breast emptying and nipple stimulation)
What kind of milk is produced by a new mother in the very early postpartum period? When does it change to regular milk?
- Colostrum - thick, small volume, IgA rich
- Milk has become regular by day 3-4
List some common maternal problems associated with lactation
- Engorgement
- Low supply
- Sore nipples
- Mastitis
- Candida infection
What are the characteristic features of a woman presenting with breast pain due to engorgement? How is it treated?
- Most common in first week
- Dull ache relieved by feeding
- Express breasts more frequently to soften breast, use firm bra, cold pack, analgesia
How might you detect that a new mother is producing a low supply of milk, and how might you treat it?
- Weight gain less than 500g/month or 150g/week or baby less than BW at 2 weeks or passing concentrated urine, lethargic, weak, dry
- Management: improve positioning and attachment. Increase number and duration of feeds, express after feeds. Metoclopramide/domperidone may help
What is the most common cause for nipple pain in breastfeeding mothers?
- Incorrect positioning
How might a woman with mastitis present? How should they be managed?
- Blocked duct and infection (heat, redness, tenderness) with associated systemic symptoms e.g. high fever
- Localised, unilateral, continuous pain not relieved by feeding
- Management: consider admission. Analgesia and fluids, continue feeding, antibiotics (flucloxacillin) oral or IV. If abscess develops, this requires drainage and breastfeeding needs to be restricted to the unaffected side during therapy
What are the features on presentation of a woman with a breastfeeding-associated candida infection?
- Risk factors: recent antibiotics, diabetes, or infant has oral thrush
- Severe pain on nursing, erythematous nipple with scaly sheen
- Treat mother and baby (different agents)
How long do new mothers generally stay in hospital? What are the broad features of the postnatal care over this period?
- Vaginal primips - 2 days, LUSCS - 4 days
- General appearance and wellbeing, vitals, uterus involution (palpation, lochia), wound assessment, urinary and bowel function, breast/nipple symptoms and signs
- Allied health review - physio, dietetics, social work, pastoral care
What are some psychosocial issues a new mother may experience?
- Sleep deprivation
- Libido/physical changes
- Family income reduction
- Role changes
- Confidence in parenting changes
- Returning to work
