Postnatal Flashcards
Contraception, Neonatal Prescribing
What are the postnatal maternal assessments (head to toe - 7 B’s)?
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
What is included in the top to toe baby assessment (daily)
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
What is puerperium?
6 - 8 weeks following the birth when the woman’s body adapts to a non-pregnant state
What is the involution of the uterus?
Normal involution of uterus with the uterus contracting back to pre pregnancy size (similar) behind pubic bone
What are the three phases of involution?
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)
What is the fundus?
The top part of the uterus that is across from the cervix
What happens in the process of involution?
- 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
Day by day progress of the fundus/uterus post birth
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
What are maternal after pains?
The uterus contracting to return to pre-pregnancy size, common during breastfeeding due to oxytocin release
Postpartum effects on the genital track (timeframe changes)
3 days post birth = cervix returns to normal consistency
10 days post birth = cervical is 1cm wide
6 weeks = cervical os a slit
What is lochia?
Postpartum vaginal discharge /loss (blood mixed with other things)
Types of lochia/time-frame
• Completed 2 -3 weeks post birth
• Rubra (red) 1 – 3 days:
• Serosa (pink) 4 – 10 days
• Alba (white) 11 – 21 days
How long should a woman breastfeed after birth?
Uninterrupted for at least 60 minutes within 1 hour of birth
What are the benefits of breastfeeding for the baby?
Lower risk of gastroenteritis, respiratory infections, SIDS, Obesity, type 1 & 2 diabetes, allergies (Asthma)
What are the benefits of breastfeeding for the mother?
Greater protection against breast and ovarian cancer and hip fractures later in life
What are the benefits of skin to skin?
reduces crying, keeps baby warmer, cardiorespiratory stability, improves bonding, more likely to breastfeed, more likely to breastfeed for longer
What are some hunger cues from the baby?
quiet alertness, stretching out, rooting, sucking sounds, tongue in and out, rapid eye movements, hand to mouth movements, crying last late sign
What should you observe for in a feed?
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
What are the signs of effective attachment in breastfeeding?
wide open mouth, chin indenting breast, lips curled out, full cheeks, sounds of swallowing, comfortable for mother, milk transfer
What is the minimum amount of times a newborn baby should be feed?
At least 8 feeds in 24 hours (3 hourly)
How does input of milk affect baby output (stool/urine)?
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.
What are the types of stool and when should they occur?
Meconium – 1 – 2/3 days
Transitional/Green – day 3 – 4/5
Yellow – day 5 onwards
Urates in urine – orange/red spots in urine
In what time frame should babies pass urine and meconium?
Within 36 hours of birth. If longer, must be referred.
What are the newborn weight loss ranges and what do they mean
Normal range - <7%
Requires evaluation and plan (typically breastfeeding plan) - Between 7 - 10%
Requires evaluation, plan and referral - >10%
How to calculate birth weight loss?
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
How many postnatal visits to the mother must a midwife do?
At least 7 PN visits and maternal check with 24 hours of birth
When does the detailed baby exam take place?
Must be done within 24 hours of birth, again within 7 days (usually day 5), again between 4 - 6 weeks
How many times must the midwife visit the home postnatally?
5 times
How soon after the mother leaving the hospital must the midwife visit her at home?
Within 24 hours
What is the time frame before a progesterone only pill is considered missed?
More than three hours
The maximum length of supply that a midwife is legally allowed to prescribe for contraception is:
Six months
what is the MAIN ACTION of progesterone-only pill that enhances its efficacy’:
Alters the cervical mucus to stop sperm traversing
Naumai phones you to say that she has missed taking 2 combined oral contraception pills. What can she do?
Take the pill now and use 7-day rule & use another contraception.
What are the timeframes after birth for placing and IUD?
Within 48 hours of birth or after 28 days
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:
Regular cleansing of the eye, gentle massage of the tear duct, and few drops of breast milk post feed.
Ruby would like her baby to have oral Vitamin K following the home birth. What statement is correct?
2mg (0.2ml) of vitamin K following birth, at 4 - 5 days and then at 4 - 6 weeks postpartum.
Baby Aimee, a week old, has a nail bed/cuticle that is red, slightly swollen following mum trimming her nails. Your plan is to:
Advise mum that Aimee needs to see a GP so an oral antibiotic treatment can be commenced.
Cherie is Hepatitis B positive. Following birth her baby would require:
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.
Hepatitis B vaccine and Hepatitis B Immune Globulin should be given to the baby of a woman who tested positive for Hepatitis B within:
12 hours
