Post-Natal

Question 1

Should you encourage breastfeeding?

Answer 1

Yes, explain that it is beneficial for the baby’s immune system, can be good for bonding and is good nutritionally
Explain the risks of galactocele and mastitis
Do not push it - some women won’t be able to or won’t want to

Question 2

What can women who don’t want to breastfeed be offered to suppress lactation?

Answer 2

Cabergoline

Question 3

What advice can you give around contraception while the woman is breastfeeding?

Answer 3

A lot of women believe that if they are breast-feeding they cannot get pregnant. This is only true if:

• the baby is <6months old
• they are completely amennorhoeic
• the woman is fully or nearly fully breast-feeding
• *if all of these factors fulfilled there is a 98% chance the woman won’t become pregnant

If at any point the breast feeding decreases (e.g. by stopping night feeds) then the effectiveness drops

Question 4

What advice can you give about post-natal contraception?

Answer 4

Options for post-natal contraception should be discussed DURING the pregnancy.
LARCs should be encouraged (coils)
these can be placed just after the delivery if the woman wants

Question 5

How long is the woman guaranteed protection for after birth?

Answer 5

21 days

Question 6

If the woman wants to start the COCP post-natally how long will she have to wait?

Answer 6

6 weeks (especially if breast feeding)

Question 7

What risks should you counsel the woman about when discussing post-natal contraception?

Answer 7

RISKS OF SUBSEQUENT BIRTH WITHIN 12 MONTHS:

• Pre-term birth
• SGA babies
• Low birth weight baby

Question 8

What does lochia consist of? When does it become concerning?

Answer 8

Shed blood, mucus and uterine tissue - NORMAL

If lochia is persisting for longer than 6 weeks postpartum then this is concerning and requires further investigation

Question 9

What are three common psychiatric problems in the post-natal period?

Answer 9

Baby Blues
Post natal depression
Post natal psychosis

Question 10

When does baby blues occur and in what % of women?

Answer 10

Usually begins on days 2-4 and peaks at day 4-6 and usually lasts for between 2-7 days.
Occurs in 50% women

Question 11

What are some symptoms of baby blues?

Answer 11

Mood disturbance 
emotional lability 
Tearfulness 
Sadness
Sleep disturbance 
Poor concentration 
Restlessness
Headaches 
Mother may feel vulnerable/rejected and feel undue concern for the baby 

Thought to have a hormonal cause

Question 12

How common is post natal depression and when does it usually occur?

Answer 12

Occurs in between 10-25% of new mothers in the first year

Peak onset is around weeks 3-4

Question 13

What are some symptoms of post natal depression and does it usually require treatment?

Answer 13

Depression
Decreased libido
Guilt at not loving or caring for baby 
Increased irritability and tiredness
Inability to cope with baby
Undue anxieties over baby's health and feeding 

In 2/3 the depression will be self limiting but in 1/3 it is severe and requires treatment

Question 14

Is post-natal depression more likely in women who have a past history of depression? What are some other risk factors?

Answer 14

Yes
Single parent
Unsupportive family
Young age

Question 15

What is the first trial of treatment in women with post-natal depression?

Answer 15

Talking therapies - talking to a non-judgemental person about their feelings

Anti-depressants and more intensive talking therapies can then be trialed if this doesn’t work

Question 16

How common is post-natal psychosis and when does it occur?

Answer 16

Approximately 1:500-1:800

Occurs around days 3-7 and peaks after 2 weeks

Question 17

What are the biggest risks with post-natal psychosis and how common are they?

Answer 17

Maternal suicide (5%)
Mother kills baby (4%)

Question 18

What are some features of post-natal psychosis?

Answer 18

Insomnia 
Mood disturbance 
Heightened suspicion 
Delusions 
Hallucinations 
Confusion 
Cognitive impairment

Question 19

What are some risk factors for developing post-natal psychosis?

Answer 19

Previous history of psychosis
Being unmarried 
Having  C/S
Developing infection
Perinatal death

Question 20

How should post-natal psychosis be managed?

Answer 20

Admit mother AND baby to specialised unit

Prognosis is good particularly if family is supportive

Question 21

What % of women with a previous episode of post-natal psychosis will go onto to have another episode in another pregnancy and what % will go on to have another episode of psychosis at any time?

Answer 21

20%

50%