Postnatal

Question 1

What are the postnatal maternal assessments (head to toe - 7 B’s)?

Answer 1

Brain - emotional wellbeing, support, exercise, sleeping, eating and drinking
Breasts - nipples, feeding, latching
Belly - palpation of fungus Blood - lochia
Bottom - perineum or c/s wound, healing, pain, bladder, bowels
Boots - swelling in the legs
Baby - fetal assessment

Question 2

What is included in the top to toe baby assessment (daily)

Answer 2

Behaviour - sleeping, activity, irritability, responsiveness, tone
Feeding - frequency, duration, effectiveness (e.g. weight, output reflecting input)
Output - urine, no. of wet nappies
Stool - no. of dirty nappies, colour
Skin - clear, colour, rashes, birthmarks

Question 3

What is puerperium?

Answer 3

6 - 8 weeks following the birth when the woman’s body adapts to a non-pregnant state

Question 4

What is the involution of the uterus?

Answer 4

Normal involution of uterus with the uterus contracting back to pre pregnancy size (similar) behind pubic bone

Question 5

What are the three phases of involution?

Answer 5

Ischaemia – when muscles of the uterus contract and retract at the third stage of labour. No more blood flow can cause after pains
Autolysis – “cleaning up process”. Myometrium cells reduced in site
Phagytocys – fibrous and elastic tissue. Never quite returns
(Process facilitated by release of oxytocin from the posterior pituitary)

Question 6

What is the fundus?

Answer 6

The top part of the uterus that is across from the cervix

Question 7

What happens in the process of involution?

Answer 7

• Reproductive organs return towards non-pregnant state
• Immediately after birth of the placenta uterus goes to halfway between umbilicus and symphysis – over next 12 hours fundus returns to umbilicus
• Height decreases approximately 1cm daily
• behind public bone by 14 days

Question 8

Day by day progress of the fundus/uterus post birth

Answer 8

Uterus weight at birth = 1kg
One week = 500gms / 5cm above the symphysis pubis
10th day = 60 - 80gms / returned to pregnant anteverted and anteflexed position
6 - 7 weeks = placental site has healed

Question 9

What are maternal after pains?

Answer 9

The uterus contracting to return to pre-pregnancy size, common during breastfeeding due to oxytocin release

Question 10

Postpartum effects on the genital track (timeframe changes)

Answer 10

3 days post birth = cervix returns to normal consistency
10 days post birth = cervical is 1cm wide
6 weeks = cervical os a slit

Question 11

What is lochia?

Answer 11

Postpartum vaginal discharge /loss (blood mixed with other things)

Question 12

Types of lochia/time-frame

Answer 12

• Completed 2 -3 weeks post birth
• Rubra (red) 1 – 3 days:
• Serosa (pink) 4 – 10 days
• Alba (white) 11 – 21 days

Question 13

How long should a woman breastfeed after birth?

Answer 13

Uninterrupted for at least 60 minutes within 1 hour of birth

Question 14

What are the benefits of breastfeeding for the baby?

Answer 14

Lower risk of gastroenteritis, respiratory infections, SIDS, Obesity, type 1 & 2 diabetes, allergies (Asthma)

Question 15

What are the benefits of breastfeeding for the mother?

Answer 15

Greater protection against breast and ovarian cancer and hip fractures later in life

Question 16

What are the benefits of skin to skin?

Answer 16

reduces crying, keeps baby warmer, cardiorespiratory stability, improves bonding, more likely to breastfeed, more likely to breastfeed for longer

Question 17

What are some hunger cues from the baby?

Answer 17

quiet alertness, stretching out, rooting, sucking sounds, tongue in and out, rapid eye movements, hand to mouth movements, crying last late sign

Question 18

What should you observe for in a feed?

Answer 18

The position of baby to breast and mother’s body (stomach to stomach), rooting, gape, position of nipple to baby (line nose up with nipple), wide latch, swallowing signs

Question 19

What are the signs of effective attachment in breastfeeding?

Answer 19

wide open mouth, chin indenting breast, lips curled out, full cheeks, sounds of swallowing, comfortable for mother, milk transfer

Question 20

What is the minimum amount of times a newborn baby should be feed?

Answer 20

At least 8 feeds in 24 hours (3 hourly)

Question 21

How does input of milk affect baby output (stool/urine)?

Answer 21

Babies that feed more will have more wet/dirty nappies and vice versa if they are not feeding enough. The colour of stool will also change colour more quickly from meconium when feeding well.

Question 22

What are the types of stool and when should they occur?

Answer 22

Meconium – 1 – 2/3 days
Transitional/Green – day 3 – 4/5
Yellow – day 5 onwards
Urates in urine – orange/red spots in urine

Question 23

In what time frame should babies pass urine and meconium?

Answer 23

Within 36 hours of birth. If longer, must be referred.

Question 24

What are the newborn weight loss ranges and what do they mean

Answer 24

Normal range - <7%
Requires evaluation and plan (typically breastfeeding plan) - Between 7 - 10%
Requires evaluation, plan and referral - >10%

Question 25

How to calculate birth weight loss?

Answer 25

Weight loss X 100 = %
Birth weight 1

10% of birth weight can be calculated by removing a zero from birth weight e.g. birth weight = 3500g, 350g is 10% lost

Question 26

How many postnatal visits to the mother must a midwife do?

Answer 26

At least 7 PN visits and maternal check with 24 hours of birth

Question 27

When does the detailed baby exam take place?

Answer 27

Must be done within 24 hours of birth, again within 7 days (usually day 5), again between 4 - 6 weeks

Question 28

How many times must the midwife visit the home postnatally?

Answer 28

5 times

Question 29

How soon after the mother leaving the hospital must the midwife visit her at home?

Answer 29

Within 24 hours

Question 30

What is the time frame before a progesterone only pill is considered missed?

Answer 30

More than three hours

Question 31

The maximum length of supply that a midwife is legally allowed to prescribe for contraception is:

Answer 31

Six months

Question 32

what is the MAIN ACTION of progesterone-only pill that enhances its efficacy’:

Answer 32

Alters the cervical mucus to stop sperm traversing

Question 33

Naumai phones you to say that she has missed taking 2 combined oral contraception pills. What can she do?

Answer 33

Take the pill now and use 7-day rule & use another contraception.

Question 34

What are the timeframes after birth for placing and IUD?

Answer 34

Within 48 hours of birth or after 28 days

Question 35

During a postnatal visit on Day 5, you note that baby Zara has a sticky eye. Zara mum wants to know what she should do:

Answer 35

Regular cleansing of the eye, gentle massage of the tear duct, and few drops of breast milk post feed.

Question 36

Ruby would like her baby to have oral Vitamin K following the home birth. What statement is correct?

Answer 36

2mg (0.2ml) of vitamin K following birth, at 4 - 5 days and then at 4 - 6 weeks postpartum.

Question 37

Baby Aimee, a week old, has a nail bed/cuticle that is red, slightly swollen following mum trimming her nails. Your plan is to:

Answer 37

Advise mum that Aimee needs to see a GP so an oral antibiotic treatment can be commenced.

Question 38

Cherie is Hepatitis B positive. Following birth her baby would require:

Answer 38

Both Hepatitis B Vaccine (5mcg - 0.5ml) in the lateral thigh of the right leg and Hepatitis B Immune Globulin (100IU - 1ml) in the lateral thigh of the left leg.

Question 39

Hepatitis B vaccine and Hepatitis B Immune Globulin should be given to the baby of a woman who tested positive for Hepatitis B within:

Answer 39

12 hours