Postnatal Care and Lactation Flashcards
When does the uterus return to the pelvis?
2 weeks
When do afterbirth pains occur?
In multiparus women, particularly when feeding
What is lochia?
Blood and decidua in the postpartum period
- 200-500ml - mean 1 month
- Changes from bright red to browny
What happens in the cardiovascular system postpartum?
Diuresis
How does the risk of coagulation change during pregnancy?
Hypercoaguable state, antenatally and postpartum
- consider thromboembolic prophylaxis
What are the benefits of breast feeding?
Reduction in atopy and infections
Less obesity/HT, higher IQ
Cheaper, more convenient
More environmentally friendly
Mother
- Reduction in breast cancer rates
- Contraception
How long is breast feeding recommended?
WHO - 2 years, exclusive for 6 months
What are some contradictions to breast feeding?
HIV positive - as long as safe preparation of milk is possible
Small number of medications
- Antineoplastic agents, ergotamine, methotrexate, cyclosporine, and radiopharmaceuticals (LactMed)
What encourages successful breast feeding?
Antenatal education Early breasting feeding, skin to skin contact Avoid supplementary feeds Encourage demand feeding Encourage 'rooming in'
How is lactation initiated?
Fall in progesterone and rise in prolactin after delivery
Supply and demand - as more is used, more is made
What is the early breast milk called?
Colostrum
What are problems with breast feeding?
Sore nipples - cracked, grazed, bleeding
Uncomfortable, engorged breasts in the early days
Low supply
How do you prevent sore nipples?
Optimal attachment - whole areolar in mouth, mouth open wide
What is low supply? How do you know?
Baby less than birth weight at 2 weeks
Weight gain
How do you improve supply?
Improve attachment and position
Increase number and duration of feeds
Post feed expressing
What is mastitis?
Blocked duct
Breast infected, indurated, painful, red area with systemic symptoms
What do you tell mum about feeding during mastitis?
Continue feeding
How is mastitis treated?
IV Fluclox
Surgical drainage if abscess
How long do you keep mothers in hospital?
2 nights primiparous vaginal delivery
4 nights caesarean
Longer stay if required
What are the psychosocial adjustments?
Sleep deprivation Libido/physical changes Cultural practices Family income reduction/role changes Confidence in parenting Returning to work/care child
What is puerperal sepsis?
Maternal temperature >38 within 2 weeks births
What are the sources of puerperal sepsis?
Retained foetal products Endometritis UTIs Surgical complications Mastitis VTE URTI - flu
What is secondary postpartum haemorrhage
Excess vaginal bleeding more than 24 hours after delivery
What is partpartum blues?
Mood swings, tearfulness, insomnia, loss of concentration
Transient
In the early postpartum period
When does ovulate after delivery?
Average 8 weeks in non-breast feeding, no period prior
Which contraceptives aren’t used in breast feeding
Non-oestrogen
What is the contraceptive coverage with breast feeding?
97% - usually accompanied with progesterone only contraceptive
