puerperium and breast feeding Flashcards
what is the puerperium?
time after childbirth lasting approximately 6-8 months
what are the key hormonal effects and physiological changes?
- Involution of the uterus
- Characteristics of lochia
- Haematological changes
- Cardiovascular changes
- Respiratory and metabolic changes
- Renal function, urinary structures and H2O metabolism
- Changes in GIT, neuromuscular, and integumentary systems
- Lactation & Breastfeeding
what is involution of the uterus?
when the uterus returns to its pre-pregnant state
why cant you palpate the fundus of the uterus 10 days after birth?
its reduced in size below the pubic symphysis
how long does involution last?
6 weeks
what does involution of the uterus involve?
changes to the myometrium and endometrium
how does the myometrium return to its normal thickness?
- ischaemia - contraction of the empty uterus = reduction of blood supply to the uterus = deoxygenation and ischaemia
- autolysis - proteolytic enzymes self-ingest myometrial cells –> removal of redundant muscle fibres and cytoplasm
- phagocytosis: phagocytes engulf and remove waste products from kidneys
what layer is a new source of the endometrium?
basal layer adjacent to the myometrium which remains intact
what layer is removed in locia?
superficial decidua layer
what is locia?
consists of RBCs, lucocytes, shreds of decidua and organism
what are the different types of locia?
o Lochia Rubra (Red) Up to 3 days
o Lochia Serosa (Pink) Up to 10 days
o Lochia Alba (Yellowish-white) Diminishes over 3-6 weeks
what haematological changes occur during puerperium?
- increase in coagulation
- Hb and haematocrit levels increase in the first few days post-partum
- increase in WBCs
- withdrawal of oestrogen = reduction in plasma volume
how long does it take for plasma volume to return to normal?
1 week after delivery
what cardiovascular changes occur during puerperium?
- reduction in plasma volume = reduction in blood circulatory volume
- Reduction in CO, HR and SV to pre-labour value
- decrease in progesterone –> removal of excess tissue fluid –> tissues return to normal vascular tone by 2 weeks
what respiratory changes occur during puerineum?
- no more shortness of breath bc reduction in lung compression bc reduction in uterine size –> allows for full inflation of lungs
- no more hyperventilation - less O2 demand bc reduction in cardiac work and circulatory volume
- all respiratory values return to normal within 6 weeks
why do you experience no more shortness of breath after delivery?
Reduction in compression of lungs due to reduction in uterine size –> full inflation of the lungs
why do you no longer experience hyperventilation after delivery?
Less oxygen demand bc reduction in cardiac work and circulatory volume
what renal changes occur?
- Dilatation of renal tract resolves
- Renal organs return to their pre-pregnant state
- Displaced bladder, dilated ureters and renal pelvis return to normal size within 8 wks.
- Increased diuresis (physiological diuresis) occurs between 2nd & 5th day
what GIT changes occur?
- GI motility, food absorption and lower oesophageal sphincter pressure are decreased during pregnancy
- Slower gastric emptying time during labour –> gastric volume is increased
- GI changes go back to non-pregnant state within 6 weeks
what neurological changes occur?
CNS and PNS are more sensitive
returns to normal 36hrs postpartum
what changes occur to the integumentary syste,s?
- Relaxin causes ligamentous relaxation + softening of collagenous tissues –> lordosis during pregnancy. (up to 5 months to return back to normal. )
- Abdominal wall and ligaments and hyperpigmentation of certain body parts e.g. face, beck and midline of the abdomen, require about 6 weeks to return to non-pregnant state
what hormones prevent lactation during pregnancy and how?
oestrogen and progesterone
inhibit milk synthesis
describe the anatomy of the breast
- 15-25 lobes
- 20-40 lobules
- Alveoli
- Milk ducts
- Lactiferous sinuses
- They contain – glandular & connective tissue, myoepithelial cells, blood, lymph, nerve & fat.
what is mamogenesis?
Mammary duct-gland growth & development
what is lactogenesis?
Initiation of milk secretion in alveoli
what is galactogenesis?
Removal of Milk from the breast
what hormones are involved in mamogenesis and when do they start to increase?
oestrogen, progesterone, prolactin and human placental lactogen
increase from 6th week
what does oestrogen do in mamogenesis?
growth of lactiferous ducts and tubules and increase in breast size
what do progesterone, prolactin and human placental lactogen (HPL) do in mamogenesis?
proliferation and enlargement of alveoli, promote fat deposition and stimulates development of lobes and lobules
describe what happens at 12, 16 and 24 weeks of mamogenesis?
- 12th week – nipple and aerola become more pigmented. Montgomery’s tubercles begin secreting lubricants
- 16th week – colostrum (first milk) formed under influence of HPL and prolactin
- 24th week – secondary alveoli have formed
what is lactation?
physiological completion of the reproductive cycle
what are the 3 stages of lactogenesis and what occurs in each of them?
o Lactogenesis I – initiation of milk secretion in breast tissue during pregnancy
o Lactogenesis II – following 3rd stage, production of colostrum and transitional milk following the fall in plasma progesterone and high levels of prolactin
o Lactogenesis III – begins about day 10 – maintenance of established lactation and removal of milk by baby
where is prolactin secreted from?
anterior pituitary
where is oxytocin secreted from?
posterior pituitary gland
where do milk ejection signals go? what triggers them?
brain to nipple
triggered by sight, sound, smell and touch of baby
what are the breast feeding benefits to the baby?
- natural food designed for the baby
- protection from infection and disease
- less chance of vomiting, diarrhoea and constipation
- better survival during first year
- right balance of nutrients
- less chance of obesity
- reduced allergies
- free, readily available and right temperature
what are the benefits of breast feeding to the mother?
- Lowers risk of breast and ovarian cancer
- Naturally uses up to 500 calories a day
- saves money
- build a strong physical and emotional bond between mother and baby.
- can give you a great sense of achievement
what are the disadvantages of breast feeding?
- Unable to measure the amount of milk baby is getting
- Some women find difficult, tiring and stressful
- Difficult to leave baby for long periods except expressing
- Father unable to feed baby
- Sometimes difficult to wean baby off the breast
how should a mother position a baby for successful breastfeeding?
- Mother should hold baby close to breast not breast to baby.
- Baby should be on his side, with head, neck & body in a straight line.
- Nose to nipple.
- Baby’s whole body should be supported.
how do you get a baby to attach to the breast?
- C – Close to mum facing breast
- H – Head free able to tilt head back
- I – In line (baby head and body straight)
- N – Nose to nipple – brush top lip with nipple
- Wide open mouth
- Suckling & swallowing
- Head is free
- Not painful for mother
what problems can occur with positioning and attachment of the baby?
sore nipples from friction
engorgement
mastitis
what is the solution for sore nipples from friction of breastfeeding?
correct attachment – Nipple at top back of mouth
what causes engorgement?
build-up of milk in ducts bc of insufficient emptying of the breast bc of incorrect positioning or restricted feeding. Hard for baby to latch on
describe the appearance of an engorged?
Breast feels hard, lumpy, painful, shiny and can result in flat nipple
what is the solution to engorged breasts?
Correct attachment, massage, hand expressing, unrestricted feeding
what is mastitis?
milk stasis and infection – if milk isn’t removed then it will back track
what are symptoms of mastitis?
breast pain, swelling, redness, fever, enlargement, changed nipple sensation, discharge, itching, tenderness and/or breast lump
what should you do if you have mastitis?
- Continue to feed, affected side first, unrestricted feeding, massage, hand expressing, analgesia, anti-inflammatory, hot/cold packs
- Antibiotics if no improvement in 12-24 hours
how should the perineum be managed during puerperium?
- Keep clean and dry to aid healing and avoid infection
* Remember pelvic floor exercises
how should the bowels be managed during the puerperium?
advice on diets and fluids
what can cause haemorrhoids and how are they treated?
- May be caused by the strain of pushing or worsen.
- Avoid long periods of standing
- Use topical analgesia
