Postnatal Care & Contraception Flashcards
What care will mothers receive in the initial days after delivery?
1) analgesia as required
2) help establishing breast or bottle feeding
3) VTE risk assessment
4) monitoring for PPH
5) monitoring for sepsis
6) monitoring BP (after pre-eclampsia)
7) monitoring recovery after a caesarean or antenatal anaemia
8) FBC check: after bleeding, caesarean or antenatal anaemia
9) anti-D for rhesus D negative women (depending on baby’s blood group)
10) routine baby check
After the initial postnatal period, new mothers will have routine follow up with a midwife to discuss topics such as:
1) General wellbeing
Mood and depression
Bleeding and menstruation
Urinary incontinence and pelvic floor exercises
Scar healing after episiotomy or caesarean
Contraception
Breastfeeding
Vaccines (e.g. MMR)
When is a postnatal appointment commonly offered by GP practices to check how the mother is doing?
6 weeks postnatal check, this is usually done at the same time as the six-week newborn baby check.
What topics are covered at the 6 week postnatal check?
1) general wellbeing
2) mood & depression
3) bleeding & menstruation
4) scar healing after episiotomy or caesarean
5) contraception
6) breastfeeding
7) fasting blood glucose (after gestational diabetes)
8) blood pressure (after hypertension or pre-eclampsia)
9) urine dipstick for protein (after pre-eclampsia)
What is lochia?
Vaginal bleeding in the period after childbirth: a mix of blood, endometrial tissue and mucus.
Describe vaginal bleeding in period after birth?
Initially, it will be a dark red colour and over time will turn brown, and become lighter in flow and colour.
Bleeding should settle within six weeks.
Why should tampons be avoided during the period after delivery?
Due to increased risk of infection.
Why is there slightly more vaginal bleeding during episodes of breastfeeding?
Breastfeeding releases oxytocin, which can cause the uterus contract.
This is normal.
How may breastfeeding affect periods?
Lactational amenorrhoea: women who are breastfeeding may not have a return to regular menstrual periods for six months or longer (unless they stop breastfeeding).
When will bottle-feeding women begin having menstrual periods after delivery?
From 3 weeks onwards (unpredictable, and periods can be delayed or irregular at first).
When is fertility considered to return after childbirth?
21 days after giving birth (contraception is not required up to this point).
How long are condoms required for when starting the COCP?
7 days
How long are condoms required for when starting the POP?
2 days
Is lactational amenorrhoea an effective method of contraception?
Yes - over 98% effective
What 2 criteria must be met for lactational amenorrhoea to be an effective method of contraception?
1) women must be fully breastfeeding
2) women must be fully amenorrhoeic (no periods)
Discuss the different contraceptive options in breastfeeding/after delivery:
a) POP
2) implant
3) COCP
4) copper coil or IUS (e.g. Mirena)
1) safe in breastfeeding and can be started at any time after birth
2) safe in breastfeeding and can be started at any time after birth
3) should be avoided in breastfeeding (UKMEC 4 before six weeks postpartum, UKMEC 2 after six weeks)
4) can be inserted either within 48 hours of birth or more than four weeks after birth (UKMEC 1), but not inserted between 48 hours and four weeks of delivery (UKMEC 3).
What is UKMEC for COCP <6 weeks postpartum?
UKMEC 4
What is UKMEC for COCP >6 weeks postpartum?
UKMEC 2
What is UKMEC for inserting copper coil or IUS within 48 hours of birth?
UKMEC 1
What is UKMEC for inserting copper coil or IUS from 48 hours of birth until 4 weeks postpartum?
UKMEC 3
What are the risks of a birth-to-conception time of less than 12 months?
Increased risk of:
1) premature delivery
2) low birth weight
3) small for gestational age babies
4) fetal mortality
How long is lactational amenorrhoea effective for?
Up to 6 months from delivery