Postnatal

Question 1

Describe the physiological process of lactation

Answer 1

1) Requires prolactin
2) Oestrogen, progesterone, insulin, thyroid hormones and glucocorticoids prime the breasts
3) Oxytocin is involved in milk release

Question 2

How is prolactin regulated?

Answer 2

A pituitary hormone

Regulated by an inhibitory factor (mainly dopamine) from the hypothalamus

Question 3

What are the complications of lactation?

Answer 3

Blocked ducts
Mastitis/abscess
Sore/cracked nipples
Engorgement

Question 4

What are the benefits to the baby of breastfeeding?

Answer 4

Passive immunity to baby

Reduces risk of sudden infant death syndrome, leukaemia, CV in adults, obesity, DMT2

Question 5

What are the benefits to the mother of breastfeeding?

Answer 5

Lowers risk of:
breast cancer
ovarian cancer
osteoporosis
cardiovascular disease
obesity

Question 6

What time is the postnatal time period defined as?

Answer 6

6-8weeks after birth

Question 7

What potentially life-threatening conditions can occur in the postnatal period?

Answer 7

Postpartum haemorrhage
Infection (GU sepsis)
(Pre-)eclampsia
Thromboembolism

Question 8

What should women receive within 3 days of birth?

Answer 8

Birth to five booklet

Question 9

What monitoring/actions should women do post-birth?

Answer 9

• BP within 6 hours of birth
• Encouraged to mobilise
• Temp
• Asked about emotional wellbeing

Question 10

At postnatal appointments what should be checked?

Answer 10

• Emotional wellbeing & fatigue
• Perineal Care/healing
• Dyspareunia (2-6weeks after birth)
• Headache
• Constipation (opened bowels within 3days of birth)
• Urinary retention (urine passed within 6hours of labour)
• Contraception (within 1st week of birth)
• Anti-D (within 72hours of delivery)
• Emotional attachment

Question 11

When should breast-feeding be commenced?

Answer 11

Encouraged to breastfeed 1hour after birth
Encourage skin-skin contact at the same time
24hours after birth women should be given information

Question 12

What are indicators of good attachment & positioning in breastfeeding?

Answer 12

• Mouth wide open
• Less areola visible underneath the chin than above the nipple
• No pain
• Chin touching breast, lower lip rolled down, nose free

Question 13

What are indicators of successful feeding in babies in breastfeeding?

Answer 13

• Audible & visible swallowing
• Sustained rhythmic suck
• Moist mouth
• Relaxed arms & hands
• Regualr soaked/heavy nappies

Question 14

What are indicators of successful breastfeeding in women?

Answer 14

• Breast softening
• Woman feels relaxed & sleepy
• No compression of the nipple at the end of the feed

Question 15

What are the normal obs of a baby?

Answer 15

RR: 30-60/min
HR: 100-160bpm
Temp: 37
Pass urine & faeces at regular intervals

Question 16

When should a complete examination of the baby take place? What does this include?

Answer 16

72hours of birth
Hx: family, maternal, antenatal and perinatal history; fetal, neonatal and infant history including any previously plotted birth‑weight and head circumference; whether the baby has passed meconium and urine
Behaviour, activity and posture
Head (fontanelles), face, nose, mouth palate, ears, neck and symmetry of head and facial features. Measure and plot head circumference
Eyes: opacities and red reflex
Neck & clavicles, limbs, hands, feet and digits; assess proportions and symmetry
Heart; check position, HR, rhythm and sounds, murmurs and femoral pulse volume
Lungs; effort, rate & sounds
Abdo; shape, organomegaly, condition of umbilical cord
Genitalia and anus; completeness and patency and undescended testes in males
Spine; inspect and palpate bony structures, integrity of the skin
Skin; colour and texture any birthmarks or rashes
CNS; observe tone, behaviour, movements and posture. Elicit reflexes only if concerned
Hips; symmetry of the limbs and skin folds (perform Barlow and Ortolani’s manoeuvres)
Cry; note sound
Weight; measure and plot
Hearing test before discharge

Question 17

What product should be given to a baby immediately after birth?

Answer 17

Vitamin K 1mg IM

Question 18

What medications are contraindicated in breast-feeding?

Answer 18

Abx: Tetracycline, Chloramphenicol, Ciprofloxacin, Sulphonamides
Lithium
Benzos
Amiodarone
Methotrexate
Aspirin
Carbimazole
Cytotoxic drugs
Sulphonylurea

Question 19

What medications are safe to use in pregnancy?

Answer 19

Abx: Trimethoprim, Penicillins, Cephalosporins
Endocrine: Levothyroxine, Glucocorticoids
Epilepsy: Carbamezepine
Heparin
Digoxin
Anti-HTN: Beta blockers, Hydralazine
Asthma meds: Theophylline, Salbutamol