Postnatal Care and Lactation

Question 1

When does the uterus return to the pelvis?

Answer 1

2 weeks

Question 2

When do afterbirth pains occur?

Answer 2

In multiparus women, particularly when feeding

Question 3

What is lochia?

Answer 3

Blood and decidua in the postpartum period

• 200-500ml - mean 1 month
• Changes from bright red to browny

Question 4

What happens in the cardiovascular system postpartum?

Answer 4

Diuresis

Question 5

How does the risk of coagulation change during pregnancy?

Answer 5

Hypercoaguable state, antenatally and postpartum

- consider thromboembolic prophylaxis

Question 6

What are the benefits of breast feeding?

Answer 6

Reduction in atopy and infections
Less obesity/HT, higher IQ
Cheaper, more convenient
More environmentally friendly

Mother

• Reduction in breast cancer rates
• Contraception

Question 7

How long is breast feeding recommended?

Answer 7

WHO - 2 years, exclusive for 6 months

Question 8

What are some contradictions to breast feeding?

Answer 8

HIV positive - as long as safe preparation of milk is possible
Small number of medications
- Antineoplastic agents, ergotamine, methotrexate, cyclosporine, and radiopharmaceuticals (LactMed)

Question 9

What encourages successful breast feeding?

Answer 9

Antenatal education
Early breasting feeding, skin to skin contact
Avoid supplementary feeds
Encourage demand feeding
Encourage 'rooming in'

Question 10

How is lactation initiated?

Answer 10

Fall in progesterone and rise in prolactin after delivery

Supply and demand - as more is used, more is made

Question 11

What is the early breast milk called?

Answer 11

Colostrum

Question 12

What are problems with breast feeding?

Answer 12

Sore nipples - cracked, grazed, bleeding
Uncomfortable, engorged breasts in the early days
Low supply

Question 13

How do you prevent sore nipples?

Answer 13

Optimal attachment - whole areolar in mouth, mouth open wide

Question 14

What is low supply? How do you know?

Answer 14

Baby less than birth weight at 2 weeks

Weight gain

Question 15

How do you improve supply?

Answer 15

Improve attachment and position
Increase number and duration of feeds
Post feed expressing

Question 16

What is mastitis?

Answer 16

Blocked duct

Breast infected, indurated, painful, red area with systemic symptoms

Question 17

What do you tell mum about feeding during mastitis?

Answer 17

Continue feeding

Question 18

How is mastitis treated?

Answer 18

IV Fluclox

Surgical drainage if abscess

Question 19

How long do you keep mothers in hospital?

Answer 19

2 nights primiparous vaginal delivery
4 nights caesarean
Longer stay if required

Question 20

What are the psychosocial adjustments?

Answer 20

Sleep deprivation
Libido/physical changes
Cultural practices 
Family income reduction/role changes 
Confidence in parenting 
Returning to work/care child

Question 21

What is puerperal sepsis?

Answer 21

Maternal temperature >38 within 2 weeks births

Question 22

What are the sources of puerperal sepsis?

Answer 22

Retained foetal products 
Endometritis 
UTIs
Surgical complications
Mastitis 
VTE
URTI - flu

Question 23

What is secondary postpartum haemorrhage

Answer 23

Excess vaginal bleeding more than 24 hours after delivery

Question 24

What is partpartum blues?

Answer 24

Mood swings, tearfulness, insomnia, loss of concentration
Transient
In the early postpartum period

Question 25

When does ovulate after delivery?

Answer 25

Average 8 weeks in non-breast feeding, no period prior

Question 26

Which contraceptives aren’t used in breast feeding

Answer 26

Non-oestrogen

Question 27

What is the contraceptive coverage with breast feeding?

Answer 27

97% - usually accompanied with progesterone only contraceptive