Week 1-4 Flashcards
What are the 4 phases of the postnatal period
1- first few hours
2- Early days
3- Early weeks
4- Completing the transition to parenthood
(Phase 1 & 2: are focused on physical recovery and psychological wellbeing)
What model of healthcare does Midwifery fall into?
Midwifery is primary healthcare in action and its practice is supported by the Social model of Health
Which 2 Millennium Development Goals (2000) refer to the postnatal period
MDG 3: Promotion of gender equality and empowerment of women
MDG 5: Improve maternal health
List some of WHO’s postnatal care recommendations
First 24 hours after birth- provide postnatal care for every birth
Hospital birth- delay discharge for 24hrs
Home births- visit women and babies within first 24hrs
Postnatal visits- provide a minimum of 4 visits for mother and baby (first 24hrs- day 3- between days 7-14- 6 weeks)
List WHO’s recommendation 8- assessment of the mother
- first 24hrs: all women have regular assessment of uterine involution, vaginal bleeding, urine void, obs. Repeat obs/urine within 6 hours
- Beyond 24hrs: contact and assessment of general wellbeing, urination/bowle habits, perineal recovery, breast and uterine tenderness, lochia
- At each visit: breastfeeding ability, emotional wellbeing, lochia, social support
- ## 10-14 days after birth: address resolution of maternal blues
Explain: Postpartum blues
- occurs in approx 75% of women
- occurs in first few days peaking around day 4/5
- usually resolved by day 10
- Symptoms: low mood, irritability, feeling overwhelmed, anxiety, insomnia, loss of appetite and tearfulness
Explain: Postnatal depression
- occurs in approx 10-16% of women
- a low mood that lasts longer than the first 10days
- symptoms: irritability, anger, guilt, lack of interest in activities, low energy and tearfulness
In low income countries most infants are breastfed to what age
1 year
What percentage of infants in high income countries are BF up to 1yr of age
20%
What was the purpose of the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (1990)
WHO/UNICEF sponsored policy makers meeting.
- This declaration encouraged National authorities to incorporate breastfeeding affirming initiatives into their health and related policy platforms.
- Ensured that facilities providing maternity services adopted the “Ten Steps to Successful Breastfeeding” set out in the joint WHO/UNICEF statement
When was the Baby-friendly Hospital Initiative launched
1992
What factors influence whether a woman will breastfeed
- intention to breastfeed prior to conception
- age
- socio-economic group,
- level of education.
- self-efficacy and confidence
What are the rates of BF
- Breastfeeding was initiated for 96% of children aged 0–2 years.
- Around 69% of infants were still receiving some breastmilk at 4 months of age, although only 39% were exclusively breastfed to 3 months, and around 60% were still receiving some breastmilk at 6 months, but only 15% were exclusively breastfed to 5 months.
- A total of 47% of infants were predominantly (fully) breastfed to 3 months, dropping to 21% predominantly breastfed to 5 months.
When did the Australian Breastfeeding Association begin?
1992 (was known as Nursing Mothers Association)
What was the purpose of the ABA
is an organisation which supports, informs and enables women to make informed choices around infant feeding for their babies.
What are some social determinants that apply to the postnatal period
Housing
Education
Social support
Culture
Explain: 4 phases of the postnatal period
Phase 1 & 2- physical recovery is a main focus of concern for most women, along with caring for and being able to breastfeed the baby.
Phase 3- as a woman’s physical recovery and parenting role progresses, she will gain confidence in her ability to care for herself and her baby.
- At some point the emotional aspects of the changes to her social world will start to have an impact.
Phase 4- the completion of the transition to parenthood. Involves a woman and her family accepting the change in family dynamics, and confidence increases
Explain: Baby Blues
occurs around day 3-10 (usually resolved)
- Signs are usually tearfulness, anxiety, irritability, low mood, tendency to cry for no reason, feel overwhelmed, tired, and for everything to ache or feel sore.
How can midwives support women with the ‘baby blues’
- help the women to have rest
- encourage family support
- ensure physical comfort (such as food, fluids, being pain free and able to get some sleep) at this time to promote wellbeing
- discuss pain relieving methods
What % of women experience the ‘baby blues’
50-80% of all women (espesically primiP’s)
What % of women experience postnatal depression
between 10-28% of all women
up to 75% of women will develop this in the antenatal period
How many lobes are there within each breast
15-20 lobes extending from the nipple
Is breast size a predictor of breastfeeding success
No
What are the small swelling located on the areola
Montgomery’s tubercles (areolar glands)
Define: Lactogenesis
refers to the ability of the breast to function as a secretory gland to synthesise and secrete breast milk and occurs across the continuum of pregnancy, birth and the postpartum period in three distinct phases.
Explain: 3 phases of Lactogenesis
Lactogenesis I- occurs during pregnancy and refers to the maturation of the mammary gland to reach the potential to synthesise breast milk.
Lactogenesis II- reflects the secretion of breast milk by the breast and occurs approximately 60 hours after birth.
Lactogenesis III- is the production and maintenance of mature breast milk and gradually occurs from the 10th to 14th day postpartum until the 4th to 6th weeks postpartum
Define: Weaning (involution)
if breastfeeding ceases or reduces in frequency, peptides in the breast milk begin to inhibit cell production and cells die with a gradual reduction of breastmilk volumes produced
What are the 2 main hormones involved in lactation
Prolactin
Oxytocin
What is the role of Prolactin in lactation
In the initial weeks following birth, breast-milk synthesis is directly stimulated by maintained plasma prolactin levels and by early frequent and effective infant suckling
- Frequent infant suckling stimulates the production of prolactin receptor sites within lactocyte cells in the alveoli, which stimulate breast-milk production once bound with prolactin
What is the role of Oxytocin in lactation
Although oxytocin does not stimulate breast-milk synthesis directly, this hormone supports the removal of breast milk from the breast with newborn suckling.
- The ‘let-down reflex’ or ‘milk ejection reflex’ is triggered when the baby suckles at the breast
- Oxytocin stimulates the contaction of the myoepithelial cells in the alveoli
Explain: 3 types of breastmilk
Colostrum- is produced from 16 weeks’ gestation and continues for the first 3–4 days postpartum. Volume ranges 2-29ml per feed
Transitional breast milk is produced between colostrum (from 3–4 days) and mature milk and lasts for approximately 10 days to 2 weeks postpartum.
Mature breast milk contains approximately 90% water with 10% proteins, carbohydrate and fats with vitamins and minerals
What type of breastfeeding preparation is available to women
- discussions with antenatal care provider
- discussion with friends and family
- antenatal classes
- breastfeeding preparation classes (ABA, hospital)
- readings books
- dad’s BF support sessions/resources
What was the purpose of the Australian Infant Feeding Surevy (AIFS)
It provides
- national baseline data on the prevalence and duration of breastfeeding
- national baseline data on other foods and drinks consumed by infants and toddlers
- national baseline data on perinatal depression
- reports on the barriers to initiating and continuing breastfeeding
Intention to breastfeed can be influenced by…
- Focus on providing the ‘best’
- Positive exposure to breastfeeding through family and friends
- A social culture which supports breastfeeding
- Supportive partner and mother
What do we know about the initation and duration of breastfeeding in Australia
initiation rates are high
duration rates are below WHO recommendations
What were the initiation of breastfeeding rates for smokers, lower education level women and high income women
Smokers- 88%
Does support play a role in the duration of breastfeeding
Yes
- professional and peer support
Mclelland et al study found 4 key themes impacting on the provision of breastfeeding support
- Guiding women over hurdles: discussing the realities of BF
- Timing and time to care: times constraints and a lack of support beyond the first couple of days
- Continuity of care: lack of continuity contributed to conflict BF advice and limited relationship rapport
- Imparting BF knowledge: more education needed for staff and consistency
List the 10 steps of successful breastfeeding
Step 1:Have a written breastfeeding policy that is routinely communicated to all health care staff.
Step 2: Train all health care staff in skills necessary to implement this policy.
Step 3:Inform all pregnant women about the benefits and management of breastfeeding.
Step 4: Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed.
Step 5: Show mothers how to breastfeed, and how to maintain lactation, even if they should be separated from their infants.
Step 6: Give newborn infants of breastfeeding mothers no food or drink other than breastmilk, unless medically indicated.
Step 7: Practice rooming-in - allow mothers and infants to remain together - 24 hours a day.
Step 8: Encourage breastfeeding on demand.
Step 9: Give no artificial teats or dummies to breastfeeding infants.
Step 10:Foster the establishment of breastfeeding support and refer mothers on discharge from the hospital
Explain: Baby led attachment
Is when a baby is placed skin to skin with the mother and during the first hours following birth the newborn infant exhibits instinctive behavioural pattern
- Sucking and rooting reflexes, hand movements, and within 1 h postpartum can find the mother’s breast and begin suckling
- 9 behavioural stages that infants exhibit when skin to skin with mother immediately after birth
What are the 9 behavioural stages a newborn goes through during baby led attachment
- birth cry,
- relaxation,
- awakening,
- activity,
- crawling,
- resting,
- familiarization,
- suckling and
- sleeping self-regulation.
What factors facilitate baby led attachment
- a semi reclined position
- skin to skin contact
- placing baby between mothers breasts upright
- allow baby to move across chest and to the nipple
- supporting baby’s neck and body (avoid holding the head as baby will move this throughout process and for breathing)
- allow baby to self-attach
Explain: Mother-led attachment
is more frequently seen and used
- mother hold baby in a comfortable position
- uses breast to open baby’s mouth with nipple aimed towards top of mouth
- inserting nipple well into the baby’s mouth once widely opened
List signs of good attachment
- baby’s chin pressed into breast with nose clear
- lips are widely spread over areola (not sucked in)
- baby has much of the areola in its mouth
- no pain for mother
- no sounds form baby’s mouth
