Week 5-7 Flashcards
Define: ALSWH
Australian Longitudinal Study on Women’s Health
Explain: Australian longitudinal Study on Women’s Health
Is assesses women’s physical and mental health as well as psychosocial aspects of health (socio-demographic factors etc) and their use of health services
What is the value of the ALSWH
- It has provided invaluable data about the health of women across the lifespan
- informed federal and state government policies across a wide range of issues
Who funded the ALSWH
Australian Government- Department of Health
What are the 5 policy goals of the 2010 National Women’s Health Policy (designed to address women’s social determinants)
- Highlight the significance of gender as a key determinant of womens health and wellbeing
- Acknowledge that women’s health needs differ according to their life stage
- Prioritise the needs of women with the highest risk of poor health
- Ensure the health system is responsive to all women, with a clear focus on illness prevention and health promotion
- Support effective and collaborative research, data collection, monitoring, evaluating and knowledge transfer to advance the evidence base of WH
What are the 4 Evidence-based priority health issues
- Prevention of chronic diseases through the control of risk factors (Cardiovascular disease, diabetes and cancer, obesity, nutrition, physical inactivity, alcohol and tobacco consumption)
- Mental health and wellbeing (Targeting anxiety, depression and suicide)
- Sexual and reproductive health; (Access to information and services relating to sexual health, reproductive health, safe sex practices, screening and maternal health. Health of mothers prior to conception, during pregnancy and in the post-natal period)
- Healthy ageing (Musculo-skeletal conditions, disability and dementia)
What type of information is gathered during a postnatal assessment
Gravida/parity
Time and type of birth
Anaesthesia or medications
Psychological and social status
Medical history, medications, allergy
Risk factors for post partum haemorrhage
Maternal status
◦ Vital signs, uterine involution, lochial loss, wound condition,
perineal pain, breast and nipple integrity
◦ Blood group and rhesus; rubella status; hepatitis and HIV status; group B streptococcus status; haemoglobin
What is the approximate reduction in fundal height following birth
1cm/day until approx 10 days
Explain: Afterpains
Is the involution of the uterus
- felt as afterpains for 4-7days
- pain is strongest in the 12-24hrs post birth
- may be associated with breastfeeding
Explain: Ischaemia
Process that causes the destruction of the myometrial cells, therefore reducing their size (not number)
When does the uterine lining begin regeneration
It begins around 10days postnatal and completed by 2-3weeks
Explain: Perineum and vaginal physical changes postnatally
- Vaginal rugae reappear by 3-4 weeks
- there is increased vascularisation of the vagina and perineum
What are the types of perineal tear’s
1st degree- injury to perineal skin
2nd degree- injury to perineum involving muscles
3rd degree- injury to perineum involving the anal sphincter complex
3a)- less than 50% of external anal sphincter (EAS) torn
3b)- more than 50% of EAS torn
3c)- both EAS and internal anal sphincter torn
4th degree- injury to perineum, anal sphincter complex (EAS and IAS), and epithelium
Explain: Postpartum blood loss
Bleeding lasts 3-6weeks Lochia Rubra (1-4days)- bright red Lochia Serosa (4-10days)- pinkish/brown Lochia Alba (10days-6wks)- clear/whitish
What is a secondary PPH
Is excessive bleeding from the first 24hrs after birth to 6-12weeks postpartum
What are the signs of a PPH
- Excessive bleeding after 24hrs post birth to 6-12wks
- deterioration of vital signs
- offensive lochia
- abdominal cramping
- uterine tenderness
- pyrexia (temp >37.5)
- enlarged uterus
List symptoms: postpartum infection
- Fever >38 degrees C
- Tender uterus, sub-involuted
- chills
- abdominal pain
- foul smelling lochia
Explain: Bladder and bowel physical recovery
BLADDER
- dilation of urinary tract returns to normal by 6wks
- women should void by 6hrs post birth
BOWEL
- can occur within 24hrs
- usually takes 2-3days to occur following birth
Deep Vein thrombosis risk increases with what 3 factors postnatally
- stasis of blood flow
- hypercoagulation
- decreased mobility
What signs may indicate DVT
- unilateral calf pain, redness or swelling
- shortness of breath
- chest pains
What is the purpose of Anti D
Prevention of haemolytic disease of the newborn in the subsequent pregnancies
- given to Rh Negative women
Anti D
Explain: Coombs test
Tests for maternal antibodies in the cord blood
Anti D
Explain: Kleihauer test
Tests for the detection of fetal cells in maternal blood
What are the signs of these life threatening conditions in the postnatal period: PPH, Infection, Pre-eclampsia/Eclampsia, Thromboembolism
PPH- sudden profuse blood loss, faint, dizzyness, tachycardia
Infection- fever, shivers, abdominal pain, offensive vaginal loss
Pre-eclampsia/eclampsia- headaches w/ visual disturbances, nausea, vomiting
Thromboembolism- unilateral calf pain, redness, swelling, chest pain
What is sexual and reproductive health affected by
- socio-economic factors
- cultural and political factors
- access to appropriate services
- representations of females in the media
- risk factors (drugs and alcohol use)
- psychosocial factors
List contraceptive methods available in Australia
- Natural family planning
- Barrier methods
- Hormonal methods - oral, injectable, implants, vaginal,
- Intrauterine devices, both hormone based and non hormone devices
- Permanent sterilisation
What type of factors do women consider then choosing a contraceptive method
- Reliability
- Reversibility
- Side effects
- Aesthetics
- Access
- Affordability
- Lactation impact
- Privacy
- Lifestyle
- Disability
- Age
Contraception methods
Explain: Lactational Amenorrhoea Method
Is exclusively BF for first 6 months. Needs to meet 3 criteria:
- BF day/night providing all nutritional needs of infant
- Amenorrhoeic (hasn’t had her period)
- baby is less than 6months old
Contraceptive methods
Explain: Fertility awareness method
It uses recognition of changes in the woman’s body at various stages in the menstrual cycle
- difficult to commence until menses have returned
- used when religious/cultural beliefs exclude contraception
When does fertility typically return after giving birth
Usually occurs from 6wks postnatal- however can sometimes occur earlier.
What is classified as the neonatal period
Newborn infant from birth until 28days old
Newborn Sensory Development
Explain: Vision
- Focus at distance of 15-20 cm
- Prefer human faces and black/white patterns
- End of first week can follow a moving object briefly
- End of second week can tell the difference between faces
- Mimic facial expressions by 12 days
Newborn Sensory Development
Explain: Hearing
- Turn towards loud sounds
- Comforted by low pitched crooning
- SWISH program
Explain: SWISH
Is a hearing program designed to identify if a newborn has a hearing problem early on that needs to be investigated and referred on
Newborn Sensory Development
Explain: Smell, Taste and touch
Smell
- Prefer smell of mother and
human milk
Taste
- Show a preference for sweet
tastes
Touch
- Enjoy skin to skin
Newborn Development
Explain: thermoregulation
Newborns thermoregulatory mechanisms are underdeveloped, so are susceptible to heat loss in first few days
- Due to large surface area, less subcutaneous fat, thin dermis, decreased ability to shiver
Newborn Development
What are the 4 ways newborns lose heat
Convection
Conduction
Radiation
Evaporation
Newborn Development
Explain: the 4 ways newborns lose heat
- Convection: the flow of heat from the body surface to cooler surrounding air
- Conduction: the transfer of body heat to a cooler solid object in contact with the baby
- Radiation: the transfer of heat to a cooler object not in contact with the baby
- Evaporation: loss of heat through conversion of a liquid to a vapour
List ways to reduce heat loss in newborns
- skin to skin
- drying baby
- wrapping
- avoiding exposure to draughts, a/c
Why are newborns given Vit K
To provide the infant with vit K within the body which is needed for clotting, as newborns do not synthesise this in their body until milk feeding is established
What is the Vitamin K prophylaxis dose
1x 1mg intramuscular injection
Newborn Development
Explain: Glucose regulation
- in utero: glucose levels are 60-70% of maternal levels
- 3rd trimester: body starts storing glycogen & depositing brown fat
- Birth: transient period of hypoglycaemia in first 2-6hrs, then a slow steady rise in the next 24hrs
Newborn Development
List signs of neonatal hypoglycaemia
Jitteriness Cyanosis Apnoea Weak cry Lethargy Lack of muscle tone Refusal to feed
Newborn Development
Explain: Physiological Jaundice
- does NOT appear in first day of life
- fades by the end of the week
- serum bilirubin levels never exceed 200-215 μmol/l
Newborn Development
If a baby is mildly jaundice what other factors need to be present to indicate action must be taken
- excessively sleepy
- reluctant to feed
- small number of wet nappies
- pale stools or orange urine
Newborn Development and Nutrition
What are the nutritional requirement for infants that are exclusively in the first 12 months of life
Birth- 6months: breastmilk (no need for water or suppliments)
6months- 12months: breastmilk and solids
Newborn Development and Nutrition
If formula feeding, what type of formula’s are recommended
Cow’s milk-based formula until 12 months
Newborn Development and Nutrition
What weight loss % for a newborn is considered normal following birth
10% in the first week of life
Newborn Development and Nutrition
When is a newborn’s birth weight usually regained after the typical 10% weight loss
Usually regained by day 10-14 of life
Newborn Development and Nutrition
What are the factors that influence newborn growth
- genetics
- environment
- nutrition
- biological causes
- health and wellbeing
List parental behaviours that facilitate bonding and attachment between infant
- Looks gazes:takes in the physical characteristics of the infant;eye contact
- Hovers: maintains proximity; directs attention to infant
- Identifies infant as a unique individual
- Claims infant as a family member; names infant
- Touches: progresses from fingertips to fingers to palms to encompassing contact
- Smiles at infant
- Talks to, coos or sings to infant
- Expresses pride in infant
- Relates infants behaviour to familiar events
List parental behaviours that inhibit or counteract bonding with the infant
- Turns away from infant; ignores infants presence
- Avoids infant; does not seek proximity; refuses to hold infant when given the opportunity
- Identifies infant with someone parent dislikes; fails to discern any of the infants unique features
- Maintains bland countenance or frowns at infant
- Wakes infant when infant is sleeping; handles roughly; hurries feeding by moving nipple continuously
- Expresses disappointment; displeasure in infant
- Does not incorporate infant into life
- Makes no effort to interpret infants action or needs
What is the most common difficulty women have when BF that leads to cessation
Nipple pain and trauma
Can previously thawed breastmilk be refrozen
No
When is a pacifier recommended if at all
Only recommended from 4weeks old (when BF established) if at all.
- Pacifiers are not needed
Define: Gelactogog
are homeopathic/herbal etc medication that helps increase milk supply
Besides attachment, what are factors can cause nipple pain
candida infection, herpes simplex infection, Raynaud’s phenomenon, bacterial infections
What Act stops women being discriminated against for BF
Federal sex discrimination act 1984
What’s the criteria for storing EBM
refrigerate after expressing in sealable containers, 6-8hrs room temp, 24hrs fridge
What is the sign of Urates in an infants urine
picky orange stains inside the baby’s nappy
What is physiological jaundice caused by
is caused by increased bilirubin production from red blood cell breakdown and decreased bilirubin clearance due to immature liver function.
- It usually appears on day 2 or 3, reaches a peak on about day 4 and fades during the second week.
Explain: Pathological jaundice
Appears before 24hrs of age
- Evidence of haemolysis
What is Kernicterus or Bilirubin encephalopathy
It is an uncommon but serious problem caused when bilirubin crosses the blood brain barrier.
List factors that can assist in preventing jaundice
- ABO and Rh blood type testing of mothers in pregnancy & Group and Coombs tests should be performed on cord blood for newborns of Rh –ve mothers
- Careful attention should be paid to feeding and hydration in the first few days of life. Dehydration major contributing factor to newborn jaundice
Watch for signs of dehydration including:
weight loss of greater than 10%,
decreased skin turgor
flat/sunken fontanelle
dry/parched mucous membranes
tachycardia, irritability, lethargy
decreased voiding or stools.
What are the management strategies for jaundice
- Determined by aetiology: Treat the cause
- Ensure adequate hydration: Breastfeeding support and regular frequent feeding
- Assess for dehydration: If signs of dehydration hydrate baby with frequent breastfeeding, EBM or supplement with formula if required
- Assessment of weight if poor feeder
- Phototherapy
- Exchange transfusion
Explain: phototherapy
Is exposure of jaundiced skin to light photoisomerise the bilirubin molecule into forms which can be excreted directly into the bile or urine, without having to be conjugated
Who discovered the first vaccine against small pox
Edward Jenner in 1796
Define: Vaccination
means having a vaccine
Define: Immunisation
means both receiivng a vaccine and become immune to a disease as a result of being vaccinated
Why do we need immunisation
to stop the spread of disease
- helps establish herd immunity (a sufficient number of people are vaccinated to halt the spread of bacteria and viruses that cause disease)
- 90% immunisation rate for most diseases helps prevent the disease spreading
- 95% immunisation rate for highly infectious diseases to prevent spread
When did routine immunisation for infants come in
Routine immunisation of infants in Australian began in the 1950’s
What do vaccines usually contain
Vaccines contain small doses of either:
- a live but weakened virus;
- a killed bacteria or virus, or small parts of bacteria; or
- a modified toxin produced by bacteria.
How do vaccines work
When a person is vaccinated, their body produces an immune response to the vaccine in the same way that it would after being infected by a disease – but without the person suffering symptoms of the disease. When a person comes into contact with that disease in the future, their immune system will respond fast enough to prevent the person developing the disease, or serious complications of the disease
At what gestation do pregnant women receive the Bootrix vaccination
around 28 weeks gestation
Explain: Immunoglobulins
are antibodies that are made by the body’s immune system to fight against infection and disease. They are normally produced by a certain type of white blood cell called a B-lymphocyte
Hep B vaccination
What are the 4 routes of transmission of Hep B
- Infected mother to neonate at birth (vertical transmission)
- Infected blood or body fluids
- Sexual contact
Horizontal transmission eg child to child through open sores
- Sexual contact
When did the Hep B immunisation program begin
in the 1980’s
What is the recommended Hep B vaccination schedule for neonates
- Monovalent Hepatitis B vaccine should be offered within 24 hours of birth (can be up to 7 days).
- Standard 3 dose Hep B schedule should then be followed at 2, 4, and 6 months (catch up of the birth dose is not necessary).
What is the recommended Hep B vaccination schedule for neonates whose mother is Hep B positive
- HBIG Hepatitis B immunoglobulin within 12 hours of birth, plus
- Monovalent Hepatitis B vaccine concurrently or within 24 hours of birth
- The doses should be administered IMI one in each thigh
- Thereafter the infant should have the standard 3 dose Hep B schedule of 2, 4 and 6 months.
Are preterm infants able to receive vaccinations
If medically stable and there are no contraindications to vaccination, preterm infants should be vaccinated according to the recommended schedule at the usual chronological age, without correction for prematurity
Contraception
Explain: Copper IUD
A copper intrauterine device (IUD) is a small plastic device which has copper wire wrapped around its stem.
(5yr and 10yr types)
- The IUD is placed inside the uterus (womb) by a doctor, to prevent pregnancy.
- The IUD has a fine nylon string attached to it.
- When the IUD is in place, the string comes out through the cervix (the neck of the uterus) into the top end of the vagina
Contraception- Copper IUD
Explain: how it works and how effective it is
- The copper IUD affects the sperm and stops sperm from fertilising the egg and affects the transport of the egg in the fallopian tubes.
- It also changes the lining of the womb, making it less suitable for a pregnancy
- The copper IUD is at least 99% effective
Contraception- Copper IUD
Explain: Side-effects
- copper IUD has no hormonal side effects
- You may have period-like cramps and bleeding or spotting in the first few days after the IUD is inserted
Contraception- Copper IUD
Explain: who can and can’t use it
CAN
- most women
- those who cannot use hormonal means,
- have completed their families,
- spacing pregnancies and who are BF
CAN’T
- Pregnant
- current pelvic infection
- abnormal vagina bleeding
- at long term risk of STI’s
Contraception- Copper IUD
Explain: Positives and Negatives
POSITIVES
- effective
- can stay in place 5 or 10 yrs
- inexpensive over time
- does not contain hormones
- immediately reversible, returning to fertility as per usual
NEGATIVES
- Can be difficult to insert (nil children born or previous C/S)
- periods may be heavier and longer, sometime more painful
- small risk of a pelvic infection at insertion
- rarely: iud can pass into uterine wall
- can fall out
- risk of ectopic pregnancy
How can midwives facilitate healthy mother-infant bonding
• providing focused midwifery labour care to limit the
need for invasive procedures and analgesia during
pregnancy, labour and birth
• encouraging participation/ support of significant
other(s) during labour and birth
• promoting skin-to-skin contact at time of birth
• routinely transitioning the well baby with other family
members
• initiating early and frequent breastfeeding, within the
first hour
• providing appropriate ongoing breastfeeding support
• avoiding or postponing any non-essential routine
procedures, such as weighing, vitamin K injection,
bathing
• promoting avoidance or postponement of any elective
procedures, such as tubal ligation sterilisation, during
the immediate postpartum period
• facilitating and supporting maternal capacities and
appropriate emotions, responses, instincts and
motivations to facilitate parenting
Explain: Habituation
is the process whereby there is an initial response to a visual or auditory stimulus such as a loud noise, followed by diminishing response with repetition until the response disappears.
- Being able to ignore a noisy environment is a newborn defence mechanism
After the first 24 hrs how wet nappies and bowel movements should the newborn be having
approximately 6-8 wet nappies and regular bowel motions usually 2-3, every 24hrs
When is the NST usually done
between 48-72 hours old
What is the NST for
it screens baby’s for metabolic diseases
- amino acid disorders
- fatty acid disorders
- other disorders
Contraception
Explain: Lactational amenorrhoea method
is the use of exclusive or near-exclusive breastfeeding for the first 6 months postpartum as a contraception method.
- 98% protection
- infant must be fed day & night providing 90% of nutritional needs
Contraception- Barrier methods
Explain: Condoms
a thin latex sheath that surrounds the penis.
- 98%-99% effective if used correctly
- protects against pregnancy and STI
- safe to use postpartum and while BF
- water-based lubricants can be used
Contraception- Barrier methods
Explain: Female condoms
similar to a standard condom. Polyurethane sheath that is inserted into the vagin prior to sex where a firm ring hold its shape near the cervix and the out ring hangs outside the vagina ready to receive the penis.
- can protect against some STI’s
- can be used postpartum and while BF
- 79-95% effective
Contraception- Hormonal
Explain: The Pill
combination of synthetic oestrogen and progestogen in a pill that must be taken at the same time every day.
- it suppresses ovulation and changes the cervical mucous to prevent sperm from entering the vagina.
- does have side-effects
- not always effective if not taken correctly
- cannot be taken when BF
