Post-Natal Flashcards
Should you encourage breastfeeding?
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
What can women who don’t want to breastfeed be offered to suppress lactation?
Cabergoline
What advice can you give around contraception while the woman is breastfeeding?
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
What advice can you give about post-natal contraception?
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
How long is the woman guaranteed protection for after birth?
21 days
If the woman wants to start the COCP post-natally how long will she have to wait?
6 weeks (especially if breast feeding)
What risks should you counsel the woman about when discussing post-natal contraception?
RISKS OF SUBSEQUENT BIRTH WITHIN 12 MONTHS:
- Pre-term birth
- SGA babies
- Low birth weight baby
What does lochia consist of? When does it become concerning?
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
What are three common psychiatric problems in the post-natal period?
Baby Blues
Post natal depression
Post natal psychosis
When does baby blues occur and in what % of women?
Usually begins on days 2-4 and peaks at day 4-6 and usually lasts for between 2-7 days.
Occurs in 50% women
What are some symptoms of baby blues?
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
How common is post natal depression and when does it usually occur?
Occurs in between 10-25% of new mothers in the first year
Peak onset is around weeks 3-4
What are some symptoms of post natal depression and does it usually require treatment?
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
Is post-natal depression more likely in women who have a past history of depression? What are some other risk factors?
Yes
Single parent
Unsupportive family
Young age
What is the first trial of treatment in women with post-natal depression?
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
How common is post-natal psychosis and when does it occur?
Approximately 1:500-1:800
Occurs around days 3-7 and peaks after 2 weeks
What are the biggest risks with post-natal psychosis and how common are they?
Maternal suicide (5%) Mother kills baby (4%)
What are some features of post-natal psychosis?
Insomnia Mood disturbance Heightened suspicion Delusions Hallucinations Confusion Cognitive impairment
What are some risk factors for developing post-natal psychosis?
Previous history of psychosis Being unmarried Having C/S Developing infection Perinatal death
How should post-natal psychosis be managed?
Admit mother AND baby to specialised unit
Prognosis is good particularly if family is supportive
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?
20%
50%
What should be checked postally?
- Maternal observations
- Maternal mental state
- Surgery-tears or CS (scars, pain relief, wounds)
- Urine and bowels
- Eating drinking
- VTE symptoms
- Anemia symptoms
- Baby-feeding and care
when is the post natal visit? ( mum and baby)
6 weeks for mum
8 weeks for baby
What is the tratment for post natal depression?
CBT
SSRI (sertraline is fine for breastfeeding)
What hormones are required for breast feeding?
Prolactin (anterior pit gland)
-production
Oxytocin (posterior pit gland)
-squeezes/contracts milk out
