Postpartum Flashcards
What is teh definition and importance of the postpartum period
- Period from the delivery of the placenta to 6/52 post natal
- The period when the changes that occurred as a result of pregnancy revert to the pre pregnancy state
- A period of great changes modifications in lifestyle, psychology, activities, relationships, responsibility, etc.
- Period of step-down of medical input if any required during pregnancy
- Potential for problems to occur
- Period continued optimal management of any pre-existing medical conditions
What is the midwife responsibility of postnatal care
In the UK, midwives have a statutory responsibility to visit the
woman and her baby in her home as required, for a period of not
less than 10 days post delivery, but also for a longer period as the
midwife considers necessary up to 28 days post delivery.
Describe the post natal examination
The postnatal examination is carried out at approximately six weeks
after delivery by the GP or by the obstetrician if the antenatal period
or delivery have been complicated. By six weeks postpartum most of
the pregnancy-induced changes in maternal physiology have
returned to normal and it is an appropriate time for assessing the
mother-infant interaction.
The examination includes an assessment of the woman’s mental and
physical health as well as feeding and behaviour of the baby. Direct
questions are asked about urinary, bowel and sexual function as
incontinence and dyspareunia or anxiety about sexual intercourse
are issues that many women will not discuss voluntarily. Blood
pressure, urinalysis and a general, breast, abdominal and
pelvic/perineal examination is performed to ascertain that the uterus
has involuted adequately and that any perineal trauma has healed.
A cervical smear is also taken if it is due and contraception is
discussed, if it has not already been initiated. The postnatal
examination is an excellent opportunity to discuss with the mother
her adjustment to parenthood and any anxieties she may have.
What are anatomical changes that can occur
Lower genital tract- these are secondary to low
oestrogen levels
- Reduction in size of vulva, vagina and cervix
- Poor lubrication of the vagina
- Transformation zone of the cervix withdraws into the endocervix
- Internal os is closed
What are physiological changes that can occur
Bleeding- initial heavy flow (lochia rubra)
- Changes from red-brown/red-pink-heavy white (lochia
alba)
- Duration of bleeding is variable, only 1:10 women still bleeding at 6/52 post partum
- Passage of clots is not normal, except for the one passed on D3/4
- Endometrium regulates
- If no lactation, new endometrium by 3/52, 1st period due by 6/52
- If lactation, ovarian activity suppressed, therefore menses
delayed by several months
What are other chanegs that can occur
Skeletal muscle- devarication of the recti,
resolves depending on pre-pregnancy laxity,
parity, level of physical activity
- Skeleton- ligament laxity resolves
- Cardiovascular function- the increased PR (by 15bpm) at term and increased cardiac output reverses by 6/52
What happens to the haemoglobin
D3 post-partum is usually characterised by diuresis, a reduction in plasma volume and an increase in the haemoglobin level. Hb normally at least 1.0 g/Dl higher by six weeks postpartum, irrespective of iron supplementation.
What happens to the white cell count
Very high levels in the immediate
postpartum period, up to 25.0 x 109/litre may be normal. Pregnancy-related changes are still present 6–8 weeks after delivery. It is thought that the heamatologic changes of pregnancy persist for longer than eight weeks postpartum.
What happens to the lately count
The platelet count in normal pregnancy and delivery usually rises rapidly back to non- pregnant values. After operative or caesarean delivery it may rise to high levels..
What happens to the serum ferritin, transferrin ,itorn
Levels are all significantly decreased at term, irrespective of iron supplementation but will return to normal levels by 5–8 weeks postpartum, irrespective of iron supplementation
What are positive feeling
satisfaction an increased closeness to her partner an increased closeness to her own mother a gradual ‘falling in love’ with the baby a feeling of protectiveness towards the baby changes in the relationship with the partner: now ‘parents’ and
not just ‘partners’.
What are negative feelings that can occur
Negative feelings may include:
dissatisfaction, disappointment or distress over the delivery
process anxiety about the baby rejection or ambivalence about the baby jealousy about the baby being the centre of attention fears of harming the baby physical discomfort and anxiety about physical damage during
birth overwhelming responsibility resentment at loss of freedom reactivation of poor relationship with own mother leading to
anxiety about repetition through generations. In some 16% of women, the early elation after childbirth can be
extreme and meets the criteria for hypomania. The rapidly falling
Describe the onset and maintenance of lactation
- Progesterone, oestrogen, prolactin, growth hormone
and adrenal steroids = hypertrophy in pre-existing alveolar-lobular structures in the breast. - Formation of new alveolae by budding from the milk
ducts, with proliferation of milk-collecting ducts. - Although there are high levels of lactogenic hormones
(prolactin and placental lactogen) in pregnancy, only minimal amounts of milk are formed, because oestrogen and progesterone inhibit their effects.
Prolactin is released by the action of suckling at a nipple that has become exquisitely sensitive post delivery
What are prolactin levels and milk production dependent on
Prolactin levels and milk production are dependent on the frequency and duration of suckling. Prolactin levels are at their highest in the early puerperium and reduce slowly, only returning to normal after weaning.
Milk secretion is also dependent on adequate emptying of the secreting glands. Accumulatin of milk inside
the alveoli will cause distention and atrophy of the glandular epithelium. Therefore, adequate milk secretion requires an intact neuroendocrine axis and adequate emptying of the breast with infant feeding.
Describe delivery of breast milk
Oxytocin= contraction of the myoepithelial cells situated around the alveolae to cause them to contract and expel the milk into the milk-collecting ducts. These milk-collecting ducts have longitudinal muscle cells, which are also stimulated, causing them to dilate and improve the free flow of milk towards the nipple along these dilated ducts.
- This leads to the ‘let down’ reflex. Oxytocin is released in response to a variety of sensory inputs including suckling, seeing or hearing the baby but is also readily inhibited by emotional stress or anxiety. There also seems to be a 90 minute cycle of ‘let down’ irrespective of suckling, because oxytocin is released in a pulsatile
manner from the pituitary.
- As lactation is initiated, the volumes are low and colostrum is initially produced. This has a high fat content and is also high in immunoglobulins. As suckling continues, the amount of milk
increases until, when fully established, approximately 800 ml per
day are produced.
