The Puerperium and Breastfeeding Flashcards
What are the normal emotional and psychological changes after pregnancy?
The ‘pinks’
- For 24-48 hours following birth
- Elevation of mood
- Excitement
- Overactivity
- Difficulty sleeping
The ‘blues’
- First 2 weeks following
- Fatigue, short-temper, difficulty sleeping, tearfulness
Not normal:
- Panic attacks
- Low mood for >2 weeks
- Low self-esteem
- Guilt/hopelessness
- Thoughts to self-harm or suicide
- ‘Biological’ symptoms
- Change in affect
What are the physiological changes during the puerperium?
Uterine involution:
- Uterus goes from 1kg to 100g
- By 2 weeks no longer palpable
Genital tract changes:
- By end of one week should be difficult to pass a finger
- By end of second week internal cervical os closed
- External os may stay open permanently
Lochia:
- Blood stained uterine discharge
- Starts as red, turns to pink, serous and then scanty-white
- Lasts for about 1 month (up to even 6 weeks)
Describe the normal recovery after normal birth
Perineal pain:
- 3-10 days post delivery
- Local cooling, topical anaesthetics
- Daily cleaning/showering
Bladder function:
- Regain control up to 8 hours after epidural
- Formal assessment at 6 hours post delivery, passing 300ml of urine
- Leave catheter in for up to 12 hours to avoid overdistension
Bowel function:
- Constipation is normal in early puerperium
Pelvic floor exercises:
- Advocated in postpartum period
Recovery after caesarean section
- Wound covered with sterile dressing, removed after 24 hours
- Sutures removed on 5th day
- Consider LMWH
What are the postnatal visits?
- 1-2 midwife visits in first 10 days (more if high risk)
- Anti-D given to Rh negative mothers
- Maternal blood pressure
- 2 week ask about baby blues
- 6 weeks formal assessment by GP
Briefly describe some puerperal disorders
- Hypertension
- Secondary postpartum haemorrhage (24 hours to 6 weeks post delivery)
- Obstetric palsy (lower limb neuralgia)
- Symphysis pubis diastasis
- Thromboembolism
- Puerperal pyrexia
- Chest complications (pneumonia, atelectasis)
- Puerperal sepsis
What is colostrum?
A yellowish fluid that is secreted by the breast as early as the 16th week of pregnancy. Replaced by breast milk by the second day postpartum.
Contains:
- High protein (immunoglobulins, IgA)
- Low sugar/fat
- Large fat globules
What are the contents of breast milk?
- Lactose
- Protein
- Fat
- Water
- IgM and IgG
Describe breastfeeding
This is suggested for at least 6 months postpartum.
Main reasons for stopping are inadequate milk, and sore/cracked nipples.
The mouth should be placed over the nipple and areola such that suction is created within the babies mouth and pulls the nipple right to the back of the mouth, at the junction between the hard and soft palate.
Babies should be fed on demand, and until feeding stops spontaneously.
Contraindicated drugs:
- Aspirin (300mg or more)
- Amiodarone
- Lithium
- Radioactive
Describe some breast disorders
Blood stained discharge
- Lasts up to a week
- Reassured
Painful nipples
- Common cause is cracked nipples
- Correct underlying problem
- Local antibiotic or breast rest
Galactocele
- Sterile, milk filled cyst
- Fluctuant swelling with minimal pain
- Resolves spontaneously
Breast engorgement
- Begins by 2nd or 3rd postpartum day
- Manual expression, cabbage leaves, ice bags, electric pumps
Mastitis
- Commonly related to breastfeeding
- Blocked milk duct
- Painful segment, red and oedematous
- Flu-like symptoms
- Culture milk and give antibiotics
- Continue breastfeeding
- May develop abscess needing drainage
Describe contraception in the puerperium
Breastfeeding:
- Can work if breastfeeding more than 80 percent of the time
Barrier:
- Best and safest at puerperium
IUD/IUS:
- Can be given within 48 hours of birth
- Best to wait 4-8 weeks to wait for involution
Progesterone only
- Better than COCP
- Started after day 21
Injectable:
- Can be given within 48 hours of delivery
- Preferably given 5-6 weeks postpartum
Not breastfeeding:
- COCP from 3 weeks
