The periuperium and breastfeeding Flashcards
what is the definition of the puerperium
The time after childbirth lasting approx.6-8 weeks
what does the puerperium include
- includes physical and anatomical changes particularly to the reproductive, urinary and cardiovascular systems
- adjustments to parenthood and its roles and responsibility as well as psychological adjustments
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
when can the fundus not be palpitated
Fundus cannot usually be palpated from 10 days following delivery as it has reduced in size to below the symphysis pubis
what is the process of involution
Involution is the process by which the uterus is transformed from pregnant to non-pregnant state
describe how involution take place and how long it takes
- Usually lasts about 6 weeks
- Involves changes to the myometrium and endometrium
by what processes does the myometrium return to its normal thickness
- ischaemia
- autolysis
- phagocytosis
describe how ischaemia causes the myometrium to return to its normal thickness
- Contraction of empty uterus and apposition of uterine walls applying pressure to placental site
- reduction of blood supply to uterus
- resulting in de-oxygenation & ischaemia
describe how autolysis causes the myometrium to return to its normal thickness
Self-ingestion of myometrial cells by proteolytic enzymes resulting in reduction in size
Removal of redundant muscle fibres and cytoplasm
describe how phagocytosis causes the myometrium to return to its normal thickness
Phagocytes engulf and remove waste products which are eliminated by the kidneys
what are the changes to the endometrium
- the basal layer adjacent to the myometrium remains intact and is the source of the new endometrium
- the decidua which is the superficial layer becomes necrotic and is sloughed off in the locia
what does the locia consist of
Consists of red cells, leucocyte, shreds of decidua and organism
describes how the locia varies in duration amount and colour
Lochia Rubra (Red) Up to 3 days
Lochia Serosa (Pink) Up to 10 days
Lochia Alba (Yellowish-white) Diminishes over 3-6 weeks
what are the haematological changes that take place after birth
Haemoglobin & haematocit concentrations fluctuate during the 1st few days postpartum
Increase in white blood cells mainly due to granulocytes
Withdrawal of oestrogen
results in gradual reduction in plasma volume returning to normal 1 week after delivery.
what are the cardiovascular changes that take place after Birth
Reduction in plasma volume = to non-pregnant state by 7-10 days
Reduction in cardiac output, heart rate and stroke volume to pre-labour value after 24 to 72hrs declining to non-pregnant value by 10-14 days
Decrease in progesterone leads to removal of excess tissue fluid resulting in tissues returning to normal vascular tone by 2 weeks.
what respiratory changes take place after birth
- no shortness of breath
- less oxygen demand as reduction in cardiac work and circulatory volume - no more hyperventilation
- all respiratory parameters return to non pregnant valves within 6 weeks postpartum
how long does it take for respiratory changes to take place after birth
6 weeks postpartum
what are the renal changes that take place after birth
- Dilatation of renal tract resolves and 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 the 2nd & 5th day following pregnancy for the excretion of broken down products placing extra work on kidneys
what happens to the GIT after birth
These gastrointestinal changes revert to non-pregnant state within 6 weeks although the mechanical effects of the gravid uterus on stomach resolve within a few days.
what happens to the neuromuscular and integumentary systems after birth
Increased sensitivity of the central and peripheral nervous system although not fully understood is thought to return to normal after 36hrs postpartum.
The hormone relaxin is responsible for both the generalized ligamentous relaxation and the softening of collagenous tissues causing lordosis during pregnancy. It can take up to 5 months to return to normal
Abdominal wall & ligaments and hyperpigmentation of certain parts of the body such as the face, neck, and midline of the abdomen, require about 6wks to return to non-pregnant state
what prevents lactation during pregnancy
High levels of oestrogen and progesterone prevent lactation during pregnancy by inhibiting milk synthesis
what happens once the placenta is delivered
Once the placenta is delivered the body quickly returns to it’s pre pregnant hormonal state.
- There is a reduction in the production of the oestrogen, progesterone and prolactin
describe the anatomy of the breast
The breast is made up of-
- 15-25 lobes
- 20-40 lobules
- Alveoli
- Milk ducts
- Lactiferous sinuses
- They contain – glandular & connective tissue, myoepithelial cells, blood, lymph, nerve & fat.
what are the changes in the breast and lactation during pregnancy
- mamogensis
- lactogensis
- galactokinesis
what is mamogensis happen
Mammary duct-gland growth & development – growth and development of the breast
what is lactogensis happen
Initiation Of milk secretion in alveoli – milk secretion
what is galactokinesis happen
- Removal of Milk from the breast
what hormones lead to mamogenesis
- Oestrogen leads to the growth of the lactiferous ducts & tubules and increase in breast size
- Progesterone, prolactin & human placental lactogen (HPL) lead to the proliferation and enlargement of alveoli, promote fat deposition & stimulates development of lobes and lobules
what does oestrogen do in mamogensis
Oestrogen leads to the growth of the lactiferous ducts & tubules and increase in breast size
what does Progesterone, prolactin & human placental lactogen (HPL) do in mamogensis
lead to the proliferation and enlargement of alveoli, promote fat deposition & stimulates development of lobes and lobules
describe how mamogensis happens
By 12th week – the nipple and areola become more pigmented. Montgomery’s tubercles begin secreting lubricants.
By 16th week – colostrum is formed under the influence of HPL and prolactin
By 24th week – secondary alveoli have formed.
how much can each breast increased by
each breast can increase by 5cms in size and 1500gms in weight
what are the 3 stages of lactogensis
- lactogenesis I
- lactogenesis II
- lactogenesis III
describe the 3 stages of lactogensis
Lactogenesis I: the initiation of milk secretion in breast tissue during pregnancy
Lactogenesis II: following 3rd stage - the production of colostrum and transitional milk following the fall in plasma progesterone and high levels of prolactin
Lactogenesis III: begins about day 10 - maintenance of established lactation and removal of milk by baby
where is prolactin produced
Secreted in anterior pituitary gland
Impulses from the nipple to the brain during feeding
how does prolactin make milk
Transported in the blood from brain to milk producing cells
Stay high for 90 mins to make milk for next feed
Level higher at night
the more the baby feeds….
the more milk that is made
where is oxytocin secretion
posterior pituitary gland
what triggers oxytocin
Impulses to the brain from the nipple and also triggered by sight, sound, smell & touch of baby
how does oxytocin release milk
Transported in the blood from brain to milk ducts to make milk flow
As baby feeds it ejects milk into baby’s mouth
Sometimes spontaneously ejects milk
what does the WHO recommend in terms of breast feeding
WHO recommends exclusive breast feeding for the 1st 6 months
what does breastmilk do in terms of immunity
Breastfeeding protects your baby from infections and diseases. – milk that provides baby with extra immunity from the mother
Fewer chest and ear
infections
Baby has less chance of diarrhoea & vomiting and therefore is less likely to be admitted to hospital
Better survival during the 1st year of life including a lower risk of sudden infant death syndrome
what are the benefits of breast feeding to the foetus
It contains the right balance of nutrients in a very easily digested form
less chance of being constipated
less likelihood of becoming obese and therefore developing type 2 diabetesand other obesity-relatedillnesses later in life
Reduces incidence of allergies - eczema & asthma
It’s free.
It’s available whenever and wherever baby needs a feed.
It’s the right temperature.
what is the benefits of breast feeding to the mother
lowers your risk of getting breast and ovarian cancer
naturally uses up to 500 calories a day (quicker weight loss)
saves money – infant formula, the sterilising equipment and feeding equipment can be costly
It can build a strong physical and emotional bond
between mother and baby.
It 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
what are the key principles for successful breast feeding
positioning and attachment
describe the positioning that the mother should have
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
what is the attachment that the mother should have
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 are the problems with positioning and attachment
Sore Nipples
Engorgement
Mastitis
describe how sore nipples occurs and what is the solution to sore nipples
- Friction – Incorrect positioning & attachment
- If in doubt or in pain – reattach
Solution
- correct attachment – Nipple at top back of mouth – No friction No Pain!
- Remember breastfeeding not nipple feeding
describe how engorgement occurs and what is the solution
Engorgement
- Build up of milk in the ducts caused by insufficient emptying of the breast due to incorrect positioning or restricted feeding
- Can cause difficulty for baby to latch on
- Breast feels hard, lumpy, painful, shinny and can result in flat nipple
Solution
- Correct attachment, massage, hand expressing, unrestricted feeding
what is mastitis
Milk stasis & infection – If milk is not removed it will back track
what is the solution to 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
what do you do to fix the puerperium
Keep clean and dry to aid healing and avoid infection
Remember pelvic floor exercises
when do you pass bowels
Usually by 3rd day after delivery
what can cause haemorrhaoids
May be caused by the strain of pushing or worsen.
Avoid long periods of standing
what can you do to fix haemorrhoids
Use topical analgesia
