The Puerperium and Breastfeeding Flashcards
Define ‘puerperium’
The time after childbirth (from delivery of placenta) to 6-8 weeks later, during which physiological and anatomical changes take place, particularly in the reproductive, urinary and cardiovascular changes
What key physiological changes occur during the puerperium?
Involution of uterus (return to normal size and tone), lochia, cardiovascular changes, hormone effects, renal function and urinary structure adaptations, lactation and breastfeeding
Describe the process of involution of the uterus
Changes to myometrium to return normal thickness (ischaemia, autolysis and phagocytosis)) and changes to the endometrium (lining shed as lochia and there is regeneration of the endometrium, superficial layer sloughs off in lochia)
What is lochia?
The normal discharge from the uterus after childbirth.
What type of lochia is present up to 3 days post-partum?
Lochia rubra; a red discharge, variable amount of fresh blood, with decidua like debris
What type of lochia is present up to 10 days post-partum?
Lochia serosa; a pink discharge which has small red cells, leukocytes and necrotic decidua
What type of lochia is present after 10 days post-partum?
Lochia alba; a yellow-white serous fluid with leukocytes and sweetish odour
Describe the haematological changes that take place in the puerperium
Transitional increase in coagulation to maximise clot formation on the 1st day afer birth, thereafter there is a reduction in plasma volume to resolve the haemodilution present in pregnancy and Hb concentration increases on the 1st day after birth to prevent any further anaemia
Describe the cardiovascular changes that take place in the puerperium
Reduced CO within 48 hours due to oestrogen withdrawal (reduction in plasma volume), increased peripheral vascular resistance, removal of excess tissue fluid resulting in return of tissues to normal vascular tone due to progesterone withdrawal
Describe the respiratory changes that take place in the puerperium
Reduction in compression of the lungs, no more shortness of breath and less oxygen demand
Describe the renal changes that take place in the puerperium
Dilatation of kidney ceases and return to their pre-pregnant state, but there is increase in diuresis and excretion of breakdown products following pregnancy which puts extra work on the kidneys
Describe the hormonal changes that take place in the puerperium
Once the placenta is delivered, there is a reduction in oestrogen, progesterone and prolactin production
Define mamogenesis
mammary duct-gland growth and development
Define lactogenesis
initiation of milk secretion in the alveoli
Define galactopoeisis
maintenance of lactation
Define galactokinesis
removal of milk from the gland
Describe the process of mamogenesis
In pregnancy, oestrogen stimulates growth of lactiferous ducts and tubules and progesterone, prolactin and hPL stimulate enlargement of alveoli and promote fat deposition. Thereafter the nipples and areola become pigmented and colostrum is formed under influence of hPL and prolactin but high oestrogen and progesterone levels prevent the formation of milk
Describe the process of lactogenesis
Initiation of milk secretion in breast tissue in pregnancy –> production of colostrum and transitional milk following fall in plasma progesterone and high levels of prolactin –> maintenance of established lactation of removal of milk by the baby (~10 days after birth)
Describe the role of prolactin in lactogenesis
secreted in the anterior pituitary gland, and impulses from the nipple go to the brain during feeding and causing prolactin secretion
Describe the process of galactokinesis
This is the milk let-down reflex performed by oxytocin secreted by the anterior pituitary gland in response to suckling and causes contraction of the myoepithelial cells surrounding the alveoli to propel the milk into the ducts and out of the nipple to feed the baby
What are the advantages of breastfeeding for the baby?
Provides immunity, less chance of D&V, fewer infections, less chance of constipation, less likely to be obese in later life and reduces allergy incidence
What are the advantages of breastfeeding for the mother?
Lowers risk of breast and ovarian cancer, facilitates faster weight loss, saves money, helps to forma stronger bond and provides a sense of achievement
What are some of the disadvantages of breastfeeding?
Unable to measure the amount of milk a baby is getting, some women find it difficult, tiring and stressful, it’s difficult to leave the baby for long periods except for when expressing, father is unable to feed the baby, sometimes it’s difficult to wean baby off the breast
What are some of the medical reasons for not breastfeeding?
Maternal infection such as HIV or certain medications which may affect the baby
What causes sore nipples in breastfeeding?
Due to friction as a result of incorrect positioning and attachment, and this can be resolved by use of correct attachment, and can rub the milk around the nipple after a feed for protection and leave to dry
What causes engorgement in breastfeeding?
Build up of milk in the ducts, causing the breast to feel lumpy, hard, painful and can result in a flat nipple. This is caused by insufficient emptying of the breast, due to incorrect positioning or restricted feeding.. This can be resolved by hand expressing, correct attachment and massage.
What causes mastitis in breastfeeding?
If milk is not removed from the breast, it will backtrack and this can lead to the development of infection, causing breast pain, swelling, discharge and tenderness. In the first instance continue to feed as normal to try and resolve milk blockage, but antibiotics should be supplied if there is no improvement in 12-24 hours
