Term
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Definition
o Initiative for reducing maternal morbidity and mortality throughout world
o First proposed in 1987 |
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Term
| Pillars of Safe Motherhood |
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Definition
• Family planning
• Antenatal care
• Obstetric care
• Postnatal care
• Post-abortion care (number 3 reason)
• STI/HIV |
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Term
| • Leading cause of maternal mortality in USA |
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Definition
o Precclampsia
2nd cause - o Indirect death (e.g. domestic violence) |
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Term
| • Leading cause of maternal mortality in world |
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Definition
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Term
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Definition
| use of current best evidence in making decisions about the care of individual patients |
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Term
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Definition
o Clinical benchmark of acceptable medical care that encompasses the learning, skill and clinical judgment ordinarily possessed and used by health care providers of good standing in similar circumstances
not necessarily based on evidence based care.
HUP's standard of care - 48 hours postpartum stay
EBC says 12 hour postpartum stay + home visit is the best |
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Term
| The most effective contraception? |
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Definition
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Term
| What improves the birth outcomes the most? |
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Definition
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Term
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Definition
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Term
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Definition
| 28 weeks in utero to 7 days postpartum |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
T - term births
P - preterm
A - abortion
L - living |
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Term
| OVarian cycle - what are the phases? |
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Definition
| Menstrual, follicular and luteal |
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Term
| Menstrual phase of ovarian cycle |
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Definition
| • Follicles are not yet growing |
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Term
| Follicular phase of ovarian cycle |
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Definition
| Follicles start to grow; end with release of ovum |
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Term
| luteal phase of ovarian cycle |
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Definition
| Post ovulation; corpus luteum is left; ovum is viable for 12-24 hours |
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Term
| • Most women’s peak time for pregnancy and fertility? |
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Definition
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Term
| • Endometrial cycle - phases? |
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Definition
| Menstrual, proliferative, secretory, ischemic |
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Term
| menstrual phase of endometrial cycle? |
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Definition
• Decrease in 2 hormones: estrogen and progesterone
• Sloughing off of the endometrium – inner lining of the uterus
• This is when a women bleeds and has her cycle |
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Term
| Proliferative phase of endometrial cycle |
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Definition
| • When the endometrial lining is proliferating (getting thicker and thicker) |
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Term
| Secretory phase of endometrial cycle |
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Definition
• Get an even thicker lining
• If the ovum was to get fertilized, there is a nice healthy bed of tissue for the ovum to embed itself into |
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Term
| ischemic phase of endometrial cycle |
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Definition
• If the ovum is not fertilized, enters ischemic phase
• Estrogen and progesterone decreases
• Blood supply decreases |
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Term
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Definition
• HPO Axis – hypothalamic-pituitary-ovarian axis
• During follicular phase; Hypothalamus secretes the gonadotropin releasing hormone
• During follicular phase; GnRH acts on anterior pituitary to secrete follicle stimulating hormone and luteinizing hormone
• During follicular phase; FSH stimulates ovary to ripen follicles, which produce small amounts of estrogen
• As dominant follicle grows, creates increase amount of estrogen
• increase level of estrogen has a negative feedback mechanism -> FSH decreases
• As estrogen increases, anterior pituitary is sensitized and secretes a burst of LH
• LH surge causes the enzymatic release of
• If ovum is not fertilized
• If ovum is fertilized
o CL continues to produce progesterone
o Estrogen is also synthesized
o This leads to negative feedback to hypothalamus to stop GnRH |
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Term
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Definition
hypothalamus - pituitary ovarian axis
look in notebook for chart |
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Term
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Definition
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Term
| • Gestational age/menstrual age |
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Definition
o First day of the last menstrual period – included in 40 weeks
o As approximate time for when pregnancy began |
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Term
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Definition
o Only 38 weeks because it does not include first 2 weeks
o Considered in embryonic research and fertility treatments |
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Term
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Definition
1st trimester - 1 to 12 weeks
2nd trimester - 13 - 27 weeks
3rd trimester - 28 - 40 weeks |
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Term
| fetal development that takes place in fallopian tubes |
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Definition
| fertilization, zygote, morula, blastocyst |
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Term
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Definition
• 23 chromosomes from sperm, 23 chromosomes from ovum
• 46 chromosomes total |
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Term
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Definition
| • Approximately 12-16 cells at this point |
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Term
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Definition
• Travels through Fallopian tubes to uterus to begin process of implantation, also called nidation
• Occurs approx. 7 days after fertilization
• Around 100 cells |
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Term
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Definition
| any pregnancy when ovum implants not in uterus - most commonly in fallopian tubes |
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Term
| number one reason for causing scar tissue in fallopian tubes |
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Definition
| STDs - chlamydia especially |
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Term
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Definition
| basalis, capsularis, true/parietal |
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Term
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Definition
| blastocyst is now called embryo |
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Term
| capsularis of endometrium |
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Definition
| o Will totally envelop the blastocyst as it embeds into the endometrium |
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Term
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Definition
| directly under blastocyst; will join with chorionic villa to create placenta |
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Term
| true/parietal endometrium/decidua |
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Definition
| o What lines the rest of the uterine cavity |
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Term
| o Embryonic period according to conceptual age (minus first two weeks) |
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Definition
• Week 1
o Fertilization and implantation
• Week 2
o Further embedding of embryo into decidua
o Cell differentiation begins
o Basic placental circulation begins
• Week 3
o Women might miss her period
o For the embryo, this is when the primitive streak is developed
• Week 4
o First sign of a heart beat
o Embryo will first fold transversely, then longitudinally
o Looks like a head and tail starting to form
• Week 5
o Rapid brain growth
• Week 6
o Further facial and head development
• Week 7
o Urogenital development
• Week 8
o Upper and lower limb development
• By the end of the embryonic period, all of the basic structures are in place – nor embryo needs to grow and mature |
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Term
| o Fetal period (11 weeks to 40 weeks in gestational age, week 9 - week 38 in conceptual age) |
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Definition
• Weeks 11-12
• External genitalia developing
• Facial development continues
• Occuring cephalocaudally (head to tail)
• Weeks 13-27
• Kidneys begin to make urine at approx. 14 weeks gestational age
• GI system – meconium (the first bowel movement)
• Hematologic system
o Bone marrow is forming blood cells and fetal hemoglobin is beginning to develop
• Hair development – lanugo (14 weeks gestational age)
o Also hair, eyebrows, eyelashes
• Senses
o Begins to respond to sound and differences in temperature
• Fetal movement
o 11-14 weeks GA
o Quickening (the maternal perception of fetal movement) – 18-20 weeks GA
o Primagravida – first time birth mother
o Multipara – multiple birth mother; will feel quickening a bit sooner, 16-18 weeks
• Brown fat is formed
o 19-22 weeks
o Heat producing fat
o Critical for newborn in maintaining temperature
• Weeks 28-40 (third trimester)
• Subcutaneous fat developing
• Skin – vernix
o Protects skin from amniotic fluid
o Both vernix and lanugo start to disappear at 34 weeks
• Sleep wake cycle
• Eyes
o Reopen at 28-30 weeks
o Open and close throughout the rest of pregnancy
• Lungs – surfactant
o Formed at 22 weeks of GA
o Surface active lipid substance that facilitates lung expansion
o Testes descend down into scrotum |
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Term
| placenta is completely formed by ___ weeks |
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Definition
10 weeks
has two placental membranes
• Chorion
• Amnion |
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Term
| we want maternal blood and fetal blood to stay separate. why? |
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Definition
• Want to avoid maternal blood recognizing fetal blood and prevent creation of antibodies
• Can hurt future fetuses
• Prevent maternal blood attacking fetal blood by giving Rhogam at 28 weeks and also at post partum |
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Term
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Definition
• Metabolism
• Synthesizes glycogen, cholesterol and fatty acids
• Endocrine
• Produces estrogen, progesterone, human chorionic gonadotropin, human placental lactigent, relaxin
• Exchange and transfer
• Simple diffusion – high to low concentration
o Oxygen, CO2, CO, H2O
• Facilitated diffusion: binding with carrier proteins
o Glucose, any of fat soluble vitamins (A, D, E)
o Placenta forms a barrier against Vitamin K (a clotting factor)
o Standard of care – vitamin K injection to every newborn
• Most babies are born without vitamin K
• Active transport: low to high concentration
o Amino acids, water soluble vitamins and minerals
• Pinocytosis: movement of large molecules via ingestion within cells
o Maternal IGG and some of the iGA antibodie |
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Term
| • Human placental lactogen |
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Definition
| potentially help with lactation process |
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Term
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Definition
| high-protein breast milk that a woman produces about 3 to 6 days after her baby is born. |
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Term
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Definition
Newborns have very small digestive systems, and colostrum delivers its nutrients in a very concentrated low-volume form. It has a mild laxative effect, encouraging the passing of the baby's first stool, which is called meconium. This clears excess bilirubin, a waste product of dead red blood cells, which is produced in large quantities at birth due to blood volume reduction, from the infant's body and helps prevent jaundice. Colostrum is known to contain antibodies called immunoglobulins such as IgA, IgG, and IgM in mammals. IgA is absorbed through the intestinal epithelium, travels through the blood, and is secreted onto other Type 1 mucosal surfaces.
Colostrum is very rich in proteins, vitamin A, and sodium chloride, but contains lower amounts of carbohydrates, lipids, and potassium than normal milk. The most pertinent bioactive components in colostrum are growth factors and antimicrobial factors. The antibodies in colostrum provide passive immunity, while growth factors stimulate the development of the gut. They are passed to the neonate and provide the first protection against pathogens. |
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Term
| 2 methods used to self-regulate one's cycle/menses |
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Definition
nuvaring, patch
also, oral contraceptives |
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Term
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Definition
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Term
| most effective form of contraception |
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Definition
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Term
| contraception with highest satisfaction rate |
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Definition
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Term
| Requires melting to be effective |
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Definition
| Vaginal contraceptive film, and vaginal spermacidal suppositories |
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Term
| caused infection from IUD in women in the 60s - class action suit |
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Definition
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Term
| most common form of family planning in third world countries |
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Definition
| Lactation Amenorrhea Method for the first 6 months (do not ovulate most of the time) |
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Term
| most widely used form of contraception in the world |
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Definition
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Term
| less sexual activity, increased use of abstinence, greater access to long-term contraceptive methods |
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Definition
| reasons for recent decrease in teen pregnancy |
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Term
| How many high-schoolers are currently sexually active? |
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Definition
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Term
| a method that only uses progesterone and is good for up to two years of use |
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Definition
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Term
| what are the risks to implanon? |
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Definition
| cardiovascular problems; potential bone density loss; amenorrhea; |
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Term
| form of contraception that is contraindicated for UTIs |
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Definition
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Term
| clear, runny cervical mucus |
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Definition
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Term
| form of contraception that produces high rate of DVT because of increased estrogen |
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Definition
| combined oral contraceptive pills! need to wait at least 6 wks before giving to postpartum women. estrogen contraceptive due to hypercoagulation after labor and delivery |
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Term
| once a month application, easy reversibility, lowers hormone levels |
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Definition
| nuvaring - can get pregnant 7 days after removal |
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Term
| form of contraception that has more difficulty with reversibility - time can be up to 1 year before normal fertility |
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Definition
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Term
| is 4 periods a year normal? |
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Definition
| Research says yes - we have our periods once a month because of our diet |
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Term
| form of contraception that deteriorates after 5 years |
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Definition
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Term
| form of contraception that produces amenorrhea in 50% of women who use it - stop getting period after 3 uses |
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Definition
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Term
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Definition
| causes hostile environment (inflammatory response in uterus) for sperm and egg - prevents them from meeting |
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Term
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Definition
99% good for up to 5 years
recommended for monogamous relationships - string acts as a wick for infection. easier to put in postpartum women (due to open cervix). best time to put it in is during period. |
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Term
| most effective form of contraception against STDs |
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Definition
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Term
| complications with contraception - ACHES |
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Definition
| abdominal pain, chest pain, severe headaches, eye problems, severe leg pain |
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Term
| prevents endometrial growth, thickens cervical mucus, inhibits sperm motility |
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Definition
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Term
| form of contraception used for both prevention and pregnancy |
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Definition
| natural family planning - count days between menstrual period and avoid pregnancy half way through |
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Term
| 2 years after last period |
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Definition
| when it is safe for menopausal women to discontinue contraception without fear of pregnancy |
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Term
| how does estrogen cause shortness of breath? |
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Definition
while progesterone relaxes smooth muscle - decreases airway resistance; estrogen increases vascularity (congestion)
pressure of the growing baby on the diaphragm will also cause SOB |
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Term
| estrogen's role in pregnancy |
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Definition
| enlarges breast and uterine tissue, increases vascularity, gums will bleed, bloody noses, nausea |
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Term
| progesterone's role in pregnancy |
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Definition
| keeps uterus from contracting; slows down GI tract and peristalsis (more absorption) = can cause constipation; |
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Term
| why is HIV more likely to be transmitted after 6 months? |
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Definition
o Baby’s immune system is dependent on mommy’s immunities until 6 months
o After 6 months, baby’s immune system becomes independent |
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Term
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Definition
DIAGNOSTIC
o Not a risk screening; involves taking a needle to withdraw amniotic fluid
o Risks infection, contraction and miscarriage |
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Term
| most significant chance of transmission of HIV |
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Definition
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Term
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Definition
0-10 cm dilation of cervix
• Early stage – 0-3 or 4 cm; also known as latent stage
• Tend to be excited; walking around; happy
• Active stage – 4- 7 or 8 cm dilated
• Contractions become stronger, longer, more intense
• Transition – 7 to 8 cm to completely dilated
• Shortest stage of labor
• Most intense
• Dilatation |
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Term
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Definition
delivery of baby
• Pushing and birth
• What makes mom want to push? – When the baby’s head gets low enough and puts pressure on the rectum |
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Term
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Definition
delivery of placenta
• Can take up to 30 min – 1 hour
• Signs – gush of blood when placenta disassociates from uterine wall
• Cord will lengthen with disassociation |
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Term
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Definition
immediate postpartum labor
• Assess fundus location – should be at or about the umbilicus
• Should be firm
• If uterus is soft or boggy – mom is bleeding
• Assess vital signs
o If blood pressure plummets – indicates bleeding and loss of blood volume
o First hour postpartum following birth of placenta
o Vital signs and fundal assessment
o Repair of laceration/episiotomy
o Breastfeeding!
o Nourish mother
o Praise |
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Term
| normal length of labor for first time moms |
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Definition
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Term
| site of births in the USA |
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Definition
• Hospital
• Birth Center
• Home |
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Term
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Definition
• Medical model
• Midwifery model |
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Term
| false labor contractions? |
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Definition
• Braxton-Hicks contractions
contractions that do not dilate the cervix |
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Term
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Definition
o Dilatation – opening
o Effacement – thinning
o Station – placement of baby’s head
o Position
o Consistency
o Presenting part
o Status of membrane – ruptured? |
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Term
| signs and symptoms of labor |
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Definition
• Prostaglandin surge
• Bishop’s Score – grade we give to a cervix
• Position
• Consistency
• Effacement
• Dilatation
• Fetal station and part |
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Term
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Definition
o Theoretical
• Maternal factors
• Progesterone
• Estrogen
• Oxytocin
• Prostaglandin
• Psyche
• Fetal factors
• Fetal cortisol
o Artificial
• Cervical exam
• Stripping of membranes – arduous cervical exam
• Prostaglandins
• Artificial rupture of membranes
• Sex
• Nipple stimulation |
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Term
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Definition
o Woman/fetus
• Power
• Influences
• Uterine force
• Nutrition and fluids
• Rest/fatigue
• Passageway
• Shapes of pelvis
o Gynecoid – most common shape
o Anthropoid
o Android
o Platypelloid
• Passenger
• Cardinal movements – position of baby’s head
• Engagement – ischial spines
• Descent – flexion; internal rotation – OT to OA
• Extension restitution – baby head realigns with body
• External rotation
• Position
• Psyche
o Providers/support persons
• Patience
• Persistence
• Practice/pain relief
• Psyche |
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Term
| pain management in active labor |
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Definition
o Walking/movement
o Hydrotherapy
o Back rubs
o Birth ball, toilet
o Maternal preference
o Analgesia/anesthesia |
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Term
| • One-on-one labor support |
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Definition
| o Somebody trained in labor support |
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Term
| • Continuous labor support |
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Definition
o Non-medical care by a trained person
o Difference between analgesia – using narcotics, IV or IM to relieve path, while anesthesia – entire body (epidural) |
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Term
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Definition
o Prolonged labor
o Labor dystocia
o Length of labor – first stage labor not impacted
o Second stage – general agreement that it is longer |
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Term
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Definition
• Monitors CTX
• Frequency
• Duration
• Less invasive
• Membranes can be intact or ruptured
• Palpation offers most maternal mobility |
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Term
| uterine pressure catheter (IUPC) |
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Definition
• Sits on uterine wall and measures pressure
• Sometimes we can’t palpate if women are obese
• Monitors CTX
• Frequency
• Duration
• Intensity
• Must have ruptured membranes
• Risks
o Trauma, maternal or fetal
o Infection |
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Term
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Definition
| more than 5 contractions in 10 minutes |
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Term
| fetal heart rate monitoring |
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Definition
o External
• Continuous – external fetal monitor
• Intermittant – EFM, Doptone/Doppler/ Fetoscope
o Internal
• Always continuous
• Fetal Scalp Electrode (FSE) = internal lead
• Direct measurement of fetal heart rate |
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Term
| fetal heart rate patterns |
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Definition
o Normal range – 110-160 bpm
o Baseline is one number, not a range
o Tachycardia
• >160 bpm (>10 min)
• Causes
• Maternal fever
• Drug administration – ephedrine
• Fetal hypoxia
• Interventions
o Depends on what’s happening
o Fever? – Tylenol
o Ephedrine? – wait 30 minutes to an hour
o Bradycardia
• < 110bpm (>10 min)
• Causes
• Cord compression or prolapse
• Fetal head compression
• Fetal hypoxia |
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Term
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Definition
• Fluctuations in the baseline FHR
• Considered to be the most important fetal heart rate characteristic
• Reflects neurological modulation of the FHR
• Don’t confuse with variables, which is a kind of deceleration
• Look at the overall fetal heart rate, not just a single variable
• Will be described as “absent variability”
• Minimal variability
• Moderate variability
• Marked variability
• Baseline is 140, and bottom is 135 and top is 150 – fluctuation/variability is 15 |
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Term
| periodic patterns for decelerations |
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Definition
o Early
• Timing: Mirrors contractions IN TIMING
o Variable
• Abrupt V shaped deceleration
o Late
• Timing: resolves after the contraction is over
• Can look similar to early
o Prolonged
• Decel lasting more than 2 minutes |
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Term
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Definition
variable = cord compression
early = o Head compression – normal during pregnancy
• Early decels – don’t do anything for it
absent = o Oxygenation
late = placental insufficiency |
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Term
| interpretation of FHR patterns |
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Definition
o Non reassuring patterns
• If favorable signs are absent
• Signs associated with hypoxia or acidosis are present
• Late decels
• Prolonged decels
• No variability
• Will most likely need STAT C/S
o Category 1: normal
o Category 2: indeterminate
o Category 3: abnormal
• Baby needs to be delivered
• Will do better breathing air than in utero |
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Term
| Nursing interventions for FHR patterns |
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Definition
• GOALS
• Improve placental blood flow
• Improve fetal oxygen supply
• Possible interventions
• Reposition patient
• IV hydration
• Oxygen administration
• Turn off Pitocin (if infusing)
• Notify primary care giver
• Consider administering tocolytic
o Something that stops contraction – terbutaline = smooth muscle relaxant
• Epidural causes vasodilation – hypotension? |
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Term
| when choosing contraception |
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Definition
Risks verses benefits
Efficacy: theory vs practice (Real/Ideal)
Abstinence is 100% effective in theory but only 80% in practice
Health problems and history
Personal quirks
Cultural acceptance
Privacy
Locus of control |
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Term
| hormonal methods of contraception |
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Definition
Implanon – only has progesterone
Oral contraceptives – estrogen
People who are obese cannot use transdermal patches – have too much SQ tissue; only effective up to 190 pounds
Depo-provera - Progesterone |
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Term
| other forms of contraception |
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Definition
Vaginal contraceptive film – looks like listerine strips; filled with spermicide; will melt from heat of vagina; best used with a condom
Sponges
Suppositories – generally used with a condom; requires melting to be effective
Cervical mucus – changes will indicate fertility
When ovulating – cervical mucus will look like egg white
Cycle beads – no chemicals involved
Sterilization – is FOREVER. Incidence of reversal is very small
Natural family planning – looking at basal body temperature; spikes right after ovulation
Abstinence
Withdrawal – pulling out
81% effective rate
ECPs – emergency contraceptive pills
Not really a form of birth control
Effectiveness rate is only 75%
ECP will make you feel sick
Plan B is just progesterone
First thing it changes is cervical mucus – impossible for sperm to pass through
Destroys corpus luteum – impossible to maintain pregnancy |
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Term
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Definition
female and male condoms, Diaphragm
Cervical cap
Dental Dam – used for oral sex |
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Term
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Definition
| first 6 weeks after birth |
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Term
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Definition
the total pregnancies, whether they have been terminated or lost
Twins – count as ONE pregnancy |
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Term
|
Definition
T = term, 37 weeks or above
P = preterm – 20 weeks to 36 weeks and 6 days
A = Spontaneous/therapeutic abortions
L = Living |
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Term
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Definition
| EDD = estimated date of delivery |
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Term
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Definition
Fetal shunts (ductus venosus, foramen ovale, ductus arteriosus
Foramen ovale – closes at first breath
Ductus arteriosus – closes after 24-48 hours
Umbilical vein – has oxygenated blood from Mom’s placenta
Artery will carry deoxygenated blood (it’s opposite)
Fetal circulation
The placenta acts as the lungs and liver for the fetus. It is a low pressure system.
The umbilical cord is the lifeline between the two.
It has two arteries that carry______________ deoxygentaed blood and waste products away from the fetus to the placenta, where these substances are transferred to mom’s circulation.
The umbilical vein carries______freshly oxygenated and nutrient laden blood from the placenta back to the fetus
Because fetus does not breathe air and the liver doesn’t have metabolic functions, the mom’s body performs these.
Three shunts in fetal circulation allow blood with the highest O2 concentration to be sent to the fetal heart and brain.
What are they?
Oxygenated blood from placenta enters fetal body via umbilical vein
Some blood goes through the liver, and the rest bypasses the liver and enters IVC though DV
The blood enters the right atrium and joins the deoxygenated blood from the lower body and head.
Most of the blood passes directly into the LA through the FO, where it mixes with the small amount of blood returning from the lungs.
Blood is pumped from the LV into the aorta to nourish the body.
A small amount of blood from the RV is circulated to the lungs to nourish lung tissue.
The rest of the blood from the RV joins oxygenated blood in the aorta through the DA.
The head and upper body receive the greatest amount of oxygenated blood |
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Term
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Definition
| Physiological and Neurological Assessment of the newborn for gestational age |
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Term
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Definition
peaks at 36 weeks
Lanugo= fine hair that covers fetus during inteuterine life; as fetus nears term it becomes thinner. Terms infants may have a small amount on the shoulders, forehead, sides of face, and back. |
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Term
|
Definition
36 weeks; by term, it has lessened
Vernix caseosa= thick white substance that provides a protective covering for fetal skin in utero. The FT infant has little vernix left on the body except in the creases. Don’t try to hard to remove it. Necessary to protect baby’s skin from amniotic fluid |
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Term
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Definition
| baby born at term has creases 2/3 down its foot |
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Term
|
Definition
Baby who is premature has dumbo ears
Pinna – is well-formed and will spring back when folded on a term baby |
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Term
|
Definition
Not completely formed in a preterm baby
Baby boy
Term – testicles, when palpated, will feel like a chick pea
Premature – testicles may not be descended and may be in the inguinal area
Scrotal rugae – a baby will have a bald, shiny scrotal sack if preterm |
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Term
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Definition
A preterm baby – can throw their arm around the body like a scarf
A term baby has greater muscle tone – will recoil |
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Term
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Definition
Newborn circulation
Fetal lungs are filled with a fluid distinct from amniotic fluid. It’s produced at a rate of 4-6cc/hr
Fetal breathing does not move amniotic fluid into the lungs.
Lung fluid contributes to amniotic fluid.
PVR is high because lungs are filled with fluid, pulmonary vessels are constricted. This results in a vascular resistance that is greater than systemic.
Blood wants to take the path of least resistance.
2-3 days prior to delivery the production of fetal lung fluid decreases dramatically.
During labor there is transport of sodium from the alveolar space to the interstitium…water follows
2/3 of fetal lung fluid is removed from the potential air space this way.
Think about c/s vs. vag delivery
Baby’s first breath is very important
Stimulated internally by hypoxemia, acidosis, hypercarbia and externally by cold and touch
Goal of lung expansion is to generate FRC; it then stimulates release of surfactant, which serves to decrease surface tension and allow alveoli to remain expanded.
This leads to a drop in PVR. When lungs expand, they fill with O2, which is a potent pulmonary vasodialator.
When the umbilical cord is cut, SVR increases b/c link to low resistance placenta is disconnected.
O2 is a constrictor of the DA.
As pulmonary blood flow increases, venous return to the left atrium increases…increased LA pressure stents FO closed.
All of these changes lead to normal newborn circulation |
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Term
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Definition
appearance - PINK
pulse - >100bpm
grimace ->cough or sneeze
activity -> active motion
respiration -> good crying
Created by Dr. Virginia Apgar, pediatrician and anesthesiologist in 1952
Assessed at 1 and 5 minutes after birth to determine how well infant is transitioning to extrauterine life
Common thing to get points off for – COLOR
Blue hands and feet (pretty normal)
Assess the baby at 30 seconds – neonatal resuscitation |
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Term
| First breath is initiated by? |
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Definition
Chemical
Chemoreceptors in carotid and aorta
Respond to decreased oxygen & increased carbon dioxide
Thermal
From warm, fluid-filled uterus to cool environment
Mechanical
Chest squeeze and recoil
C-section babies have respiratory distress because they don’t get mechanical stimulation of being pushed through vagina
TTN –transient tachypnea of newborn |
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Term
| Respiratory system in newborns |
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Definition
Respiratory rate
40-60 breaths per minute
Periodic breathers
Obligate nose breathers
Grunting, Flaring, Retractions…not normal
Periodic- can have about 15 seconds of apnea |
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Term
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Definition
Heart rate
120-160 beats per minute
Not abnormal to hear murmur
Functional closure of the DA occurs within 15-24 hours after birth; closes permanently by 3-4 weeks.
BP – check for discrepancies in arm and leg to check for cardiac anomalies |
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Term
| neurological system in newborns |
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Definition
What’s normal
Reflexes
Activity states
Thermoregulation (normal temperature)
Axillary 36.5-37.5°C (97.7-99.5°F)
Rectal 36.5-37.6°C (97.7-99.7°F) |
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Definition
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Definition
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Definition
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Definition
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Definition
| – stroke the baby’s foot, toes flare |
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Term
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Definition
| Stepping – hold baby in upright position, feet will step |
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Term
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Definition
| Quiet sleep= infant in deep sleep, closed eyes, no eye movements, RR quiet, regular, slower |
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Term
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Definition
| = infant moves extremities, stretches, change facial expressions, may fuss, REM (don’t mistake for waking up) |
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Term
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Definition
| = transitional state b/t wake and sleep states, can move to either one |
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Term
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Definition
| = parents should learn to identify this state, excellent time for bonding, body movement is minimal, infant concentrates on environment |
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Term
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Definition
| often fussy, seem restless, have more irregular and faster RR, seem more aware of feelings of discomfort from hunger, cold |
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Term
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Definition
| may quickly follow the active alert state if no comfort intervention occurs; may take a period of comfort to move infant to a state in which feeding or other activities can be accomplished |
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Term
| baby will be in what stage first after birth? |
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Definition
Baby will be in drowsy sleepy stage first two days after delivery – normal; may not want to feed
First 2 hours is best for breastfeeding |
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Term
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Definition
| wet surface exposed to air, as surface dries, heat is lost (after birth, bathing |
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Term
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Definition
| = when babies come in direct contact with object cooler than they are (scale, circ board, cold hands, stethoscope); opposite is also true…warm blankets |
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Term
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Definition
| (the movement of air)= when heat is transferred to air surrounding the infant, air currents from people moving around, A/C; keep away from drafts |
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Term
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Definition
| transfer of heat to cooler objects that are not in direct contact with infant (placed near cool window, transfer heat to walls of incubator; opposite = radiant warmers |
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Term
| primary method of heat production in newborns |
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Definition
= Nonshivering thermogenesis…the metabolism of brown fat
brown fat= special kind of highly vascular fat found only in NBs; located around back of neck, in axillae, around kidneys, adrenals, and sternum, b/t scapula and along abdominal aorta
when it’s metabolized it generates more heat than other fats, blood passing through is warmed and carries heat to the rest of the body |
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Term
| cold stress can cause...? |
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Definition
| Cold stress can cause decrease in production of surfactant; prolonged cold stress can lead to respiratory difficulty even in a healthy term NB= baby will shiver from cold stress = leads to decreased glucose level |
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Term
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Definition
Vitamin K given IM at birth to prevent hemorrhagic disease of the NB. It’s necessary to activate several of the clotting factors. It is synthesized in the intestines, but food and normal intestinal flora are needed
Vitamin K shot at birth – synthesized in the gut |
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Term
| baby can lose up to ___ of birth weight? |
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Definition
Baby loses 10% of birth weight in first day
By 2 weeks, baby should regain this loss of weight |
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Term
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Definition
Football hold – good for moms with big breasts; c-section patients
Cradle – head in crook of their elbow and hand on butt |
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Term
| intake needed for breastfeeding and formula babies |
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Definition
DOL 1- nurse within an hour of birth; goal= 6-8 feeds in first 24hrs (5-10minutes/breast)
DOL 2- 8 feeds/24hrs, at least 5-10 minutes/breast
DOL 3- 8/24hrs, at least 10 minutes/breast; baby may seem insatiable
DOL 4- milk comes in, 8/24hrs, don’t let baby sleep >4hrs, feeds at least 15 minutes/breast (use both to stimulate supply)
Formula fed infants eat 2-3 oz q 3-4 hours, don’t let baby sleep >4hrs
By 2mos taking about 4 oz/feed q 3hrs |
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Term
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Definition
Meconium is the first stool excreted; it is composed of particles from the amniotic fluid (skin cells, hair), along with cells shed from the intestinal tract, bile, and other intestinal secretions. It is greenish-black with a tar-like consistency
The first meconium stool is passed within the first 12 hours of life and 99% of neonates have passed meconium within 48 hours. Failure to do so leads to suspicion of obstruction. |
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Term
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Definition
| The 2nd type of stool is transitional stool. It is greenish brown and looser consistency than meconium. They are a combo of meconium and milk stools and depend on what type of milk the infant is getting. |
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Term
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Definition
| Stools of BF infants are seedy and the consistency of mustard with a sweet-sour smell. BF infant generally has more stools than the formula fed infant (may be as many as 10/day or as few as one every 2-3 days in older infants) |
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Term
| formula fed infant stools |
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Definition
| Formula fed infants excrete pale yellow to light brown stools which are firmer in consistency than those of BF babies. They may have several stools/day or only 1-2. Do not smell as pleasant. |
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Term
| newborns and their weight |
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Definition
Typical weight loss= 5-10% of BW due to loss of extracellular water; should regain by 10 days of age
Expected weight gain= from DOL 4-3mos gain about ½ lb/week; babies double BW by 4-5mos, triple it by 1 year; quadruple by age 2
BF babies gain slightly less than formula fed babies from 4-6mos, may look like they aren’t growing…new WHO growth charts |
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Term
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Definition
Normal= Labia majora= dark, should cover clitoris and labia minora, urinary meatus and vagina should be present; mucus discharge or pseudomenses= variations of normal
Abnormal if clitoris and labia minora > labia majora (preterm infant) |
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Term
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Definition
Normal= may have darkened scrotum, descended testes within scrotal sac, rugae on scrotum, meatus at tip of penis
Abnormal= testes in inguinal canal or abdomen, lack of rugae (PT), enlarged scrotal sac (hydrocele), small penis/scrotum (PT or ambiguous genitalia), urinary meatus on upper (epi-) or underside (hypospadius) of penis |
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Term
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Definition
| The first void should occur within 24 hours of birth. Only 2-6 voids may occur in first couple days, but after that, infants should have at least 6 wet diapers/day. |
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Term
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Definition
Should be able to feel fontanelles; suture lines
Will be shaped like a cone when coming out of the vaginal canal |
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Term
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Definition
Bump on the head; usually caused by trauma
Caput succedaneum occurs as a result of pressure against mothers cervix during labor, pressure interferes with blood flow causing localized edema at birth; crosses suture lines; soft, varies in size, resolves quickly, disappears within 12 hours – several days after birth, may also occur when vacuum extractor is used |
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Term
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Definition
| Cephalohematoma, bleeding occurs b/t periosteum and skull as result of pressure during birth, this firm swelling is not present at birth but develops within the first 24-48 hours, confined by suture lines, reabsorbs slowly and is generally gone within a few weeks after birth (jaundice risk) |
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Term
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Definition
Discuss molding, over-riding sutures that form ridges, fontanelles (anterior usually closes by 18-24 months and posterior usually closes at 2-6 months).
Also examine eyes (too far apart) and ears (low set) |
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Term
| if something is wrong with ears at birth, also check the? |
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Definition
| Ears and kidneys form at the same time – if something’s wrong with the ears, check the kidneys |
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Term
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Definition
Stork bites
Mongolian spots
Strawberry hemangiomas
Port wine stain |
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Term
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Definition
A stork bite is a common type of birthmark seen in a newborn. It is most often temporary.
The medical term for a stork bite is nevus simplex. A stork bite is also called a salmon patch.
Causes Return to top
Stork bites occur in about one third of all newborns.
A stork bite is due to a stretching (dilation) of certain blood vessels. It may become darker when the child cries or room temperature changes. It may fade when you push on it.
Symptoms Return to top
A stork bite usually looks pink and flat. A baby may be born with a stork bite, or the birthmark may appear in the first months of life. Stork bites may be found on the forehead, eyelids, nose, upper lip, or back of the neck. |
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Term
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Definition
This is a very common benign skin pigmentation occurring frequently in Polynesian, Asian and Mediterranean babies but also, though to a much lesser extent, in Europeans.
Although the intergluteal area is the most common site, similar lesions may occur over the trunk or extremities and at times multiple lesions may be noted. Such lesions have been confused for bruises of child abuse. They gradually fade during the first few years of life. |
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Term
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Definition
Hemangiomas are simply a collection of extra blood vessels in the skin
It is a benign growth. They may have different appearances depending on the depth of the increased numbers of blood vessels.
Strawberry Hemangioma is an abnormal collection of blood vessels in the skin characterized by a bright red color and well-defined border.
Hemangiomas are one of the most common birthmarks in newborns. Most hemangiomas are not present at birth but develop within the first few weeks to months of life. They are found in up to 10 percent of babies by the age of one.
The cause of hemangiomas is unknown. In very rare instances they may run in families, but in general they are not inherited. They are also more commonly seen in premature infants.
Hemangiomas usually involute (shrink away) in time. 30% of hemangiomas will resolve by 3 years of age 50% by 5 years of age, and 80%-90% by 9 years of age. Over one-half of hemangiomas heal with an excellent cosmetic result without treatment. |
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Term
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Definition
| Vascular malformation, can be treated with pulse dye laser |
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Term
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Definition
Normal newborn jaundice
Pathological – born with jaundice; soars over days; can lead to brain damage
Teaching parent about jaundice
Let the baby get UV light to break down old red blood cells
Importance of having baby taking enough fluids to clear jaundice |
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Term
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Definition
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Term
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Definition
Hygiene - start bathing baby when the umbilical cord falls off
Activity
Safety
Informed consent (immunizations…)
Growth spurts
2 weeks, 6 weeks
Cry more when they’re going through growth spurt because they are hungry
Neogen/PKU screening
Phenylketonuria - needs special diet for rest of life; NO phenylalanine
Build up of phenylalanine can cause mental retardation
Maple syrup urine disease
Cystic fibrosis
Sickle cell |
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Term
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Definition
What does the research say?
Not really a difference re: time until cord falls off and incidence of ompalitis
Teach parents to recognize signs and symptoms of infection (redness, oozing, foul smell) |
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Term
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Definition
Pain relief
Local anesthetic
Sugar water on pacifier
Dermal lidocaine
EMLA cream
Diapering
Why do we do
this, anyway?
No medical indication for procedure, parental choice, informed decision
Sucrose and penile block
Vaseline or A&D ointment to penis until healed (yellow scabbing) |
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Term
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Definition
Look for quiet alert state to interact
Teach infant cues for overstimulation
Interaction
Stimulation
Crying Curve
Sleep
BACK to sleep; prevent SIDS |
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Term
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Definition
Increase 2-3 weeks
Peak during 2nd month of life
Decline by 4th or 5th month
Universal
Babies will cry generally in later afternoon to bedtime at night
Ron Barr article
Average daily duration of crying begins to increase about 2-3 weeks of age, peaking sometime in the second month of life and declining to more stable levels by the 4th or 5th month.
Similar patterns described in hunter-gatherer societies, low risk PT infants, and nonhuman primates. Led to the proposal that this pattern is a behavior universal of infancy.
Important to let parents know, anticipate coping mechanisms |
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Term
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Definition
Sleep needs (baby and parents)
Days and nights mixed up
Co-sleeping – dangerous; not supposed to have lots of blankets and comforters
If sleeping in a fetal position – cconsidered acceptable for co-sleeping
Babies spend 50-80% of their sleep time in REM (we spend 25%)…they move a lot and are noisy, but not awake
Birth-2mos- NB sleep 16-18 hours/day, may have day-night reversal, rarely sleep >4h at a time; babies don’t have neurologic maturity to relax and fall asleep on their own
***wake up NB is sleeps >3hrs during the day to help him/her have longer stretch at night
Don’t let NB sleep >4hrs at night, need to eat (until BW regained)
2-4 months- 14-16hrs/day, usually take 3 naps/day, may sleep 6 hour stretch at night; too early to train baby to sleep, but need to start establishing good sleep habits
4-6 months- 14-15hrs/day, 2 naps, should sleep at least 6hrs/night, some up to 12
6-12 months- 13-14hrs/day, 2 naps, most sleep 10-12hrs straight at night |
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Term
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Definition
Car seat
Mandated up to age of 4
Backwards in car up to 1st year
“Back to sleep”
Prevention of SIDS
Co-sleeping
Shaken Baby Syndrome
DO NOT SHAKE BABY |
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Term
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Definition
Every 15 minutes after birth X 1 hour
Every 30 minutes for next 2 hours
Every hour for up to six hours
Every 4 hours during first 24 hours
>24hrs very 8 hours unless problems arise
Temperature (< 100.4 F)
Heart rate (60-90 bpm)
increase blood loss-watch pulse
Blood pressure (<130/90)
increase blood loss-watch BP
orthostatic hypotension
Respirations (12-20)
Cesarean birth-lung auscultation is key! |
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Term
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Definition
RPR = serology (tests for syphilis)
3rd trimester labs
CBC redone
HepB status redone
RPR – not let a baby go home without the results
HIV – mom may decline
@ HUP
Urinary tox screen – drug history
GBS
Gonorrhea/Chlamydia |
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Term
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Definition
Hemoglobin: 11.5g/dl
White Blood Cells: 6,000-10,000
Platelets: 150,000-400,000
HIV: negative
RPR:negative
Rubella: Immune
Hepatitis B Surface Antigen: negative |
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Term
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Definition
ACOG recommends Rubella vaccine postpartum to protect mom from contracting measles; therefore, protecting future babies from contracting Rubella Congenital Syndrome
Attenuated live vaccine
Recommended to avoid pregnancy 4wks after vaccine is given
Ok with breastfeeding?
Dose: 0.5ml SQ X1 in upper outer aspect of upper arm |
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Term
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Definition
If mother is Rh negative and baby is Rh positive, Rhogam to be administered within 72 hours after delivery to prevent dev’t of maternal antibodies that would affect FUTURE babies
Dose: 300mcg IM x1
(Deltoid muscle recommended)
Only time you need it if mom is a negative bloodtype and baby is positive bloodtype
Mom may receive rhogam intrapartum If her bloodtype is found as negative during pregnancy
May receive it again when baby is born and learns of bloodtype
If mom is positive – no need to go rhogam
Mom may develop antibodies after 72 hours |
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Term
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Definition
Breasts
Uterus
Bladder
Bowels
Lochia
Episiotomy
Pain
Legs
Emotional Status
Bonding |
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Term
| Breasts postpartum assessment |
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Definition
Ask your patient: Are you breast or bottle feeding your baby?
Visually assess breasts
Palpation: Perform breast exam. Is there any areas of tenderness? Assess for engorgement
Nipple assessment: Inspect for flat, retracted nipples & for trauma such as redness, blisters, fissures from breastfeeding
Education: Breastfeeding, breast pumping,
bottle feeding, combination? |
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Term
| uterus postpartum assessment |
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Definition
Determine firmness, fundal height, descent of uterus documented in relation to umbilicus: Fundus @U, U-1, U-2, and position of uterus in relation to abdomen
First 24hrs, fundus is at level of umbilicus
Descends by approximately 1cm
(1 fingerbreadth) per day
By 2nd week, fundus tucks back in the pelvic cavity and cannot be palpated anymore |
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Term
| why do we care about uterine involution? |
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Definition
Why do we care about uterine involution?
Uterus does not involute properly
Subinvolution occurs
Causes postpartum hemorrhage |
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Term
| if patient has c/s or bilateral tubal ligation |
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Definition
Assess abdominal incision:
Redness
Ecchymosis
Edema
Drainage
Approximation
If drainage present, assess:
Color
Odor
Consistency
Amount |
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Term
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Definition
Ask patient: Are you urinating without any problems?
Changes during pregnancy cause bladder to have increased capacity & decreased muscle tone
Urethra, bladder & meatus become edematous & traumatized by fetal head. May lead to decreased sensitivity to fluid pressure No sensation to void despite bladder distention
Education: Kegel exercises, do not restrict po fluids
C-Section pts will usually have a foley for 1st 12hrs post-op, then DTV 6 hrs after foley d/c’d
DIURESIS after childbirth
Bladder fills rapidly
Bladder overdistention, incomplete emptying, retention of urine
UTI PPH |
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Term
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Definition
VAGINAL Delivery:
Ask patient: Are you eating without any problems? Are you passing gas? Have you made a bowel movement yet?
New mom is hungry after using energy during labor
Thirsty- po fluids, mouth breathing, fluid loss from exertion
Constipation common because of progesterone
Consider perineal trauma, episiotomy, hemorrhoids, FeSO4
Mom hesitant to exert pressure on perineum
Consider stool softeners
Caesarean Section:
Ask patient: Are you passing gas?
Have you made a bowel movement yet?
Assessment
Visual: Distention?
Auscultation: +BS?
Palpation
Percussion: Tympany?
Delivery-12h: NPO (Ice is ok)
12-24h: Usually clear diet
>24h: If +BS, +flatus; usually ok for regular diet |
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Term
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Definition
Assessment
Ask patient: Is your bleeding slowing down? Are you passing clots? How often are you needing to change your pads?
C-Section patients ALSO have lochia
Assess quantity, amount, and odor of lochia
Lochia: rubra, serosa, alba
Education: Bleeding precautions
Rubra – 1-3 day postpartum
Serosa – within 4-10 days; pink to brown color
Alba – 11-21 days, white to light yellow
Bleeding should be getting less and less |
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Term
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Definition
Inspect perineum for:
Redness
Ecchymosis
Edema
Drainage
Approximation
Education: Ice pack (great in first 24 hours for decreasing pain), dibucaine, witch hazel pads, sitz bath. Pelvic rest x 6 weeks. May take 4-6 weeks to 4-6 months, depends on degree |
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Term
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Definition
| First Degree Laceration involves only the lining or mucosa of the vagina |
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Term
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Definition
Second degree tears involve the vaginal lining and the deeper
(submucosal) tissues but do not involve the anal sphincter or rectum. |
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Term
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Definition
| Third degree tears extend from the vaginal lining through the anal sphincter but do not involve the rectal lining. |
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Term
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Definition
| Fourth degree tears include the vaginal lining, submucosal tissues, anal sphincter, and rectal lining. |
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Term
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Definition
Assess pain with each time you encounter pt
Sources of pain: Episiotomy, laceration site, hemorrhoids, c/section incision, engorged breasts, cracked nipples, back pain from epidural, uterine cramps
Non-Pharmacologic Interventions
Breathing and relaxation techniques (yes, just like labor)
Therapeutic touch or massage
Imagery
Warm packs
Cool packs
Distraction
Interaction with infant
Pharmacologic Interventions:
Usual dosing
Motrin- 600mg 1Tab po Q6H prn pain or 800mg 1Tab po Q8H prn pain
Tylenol- 325mg 2tabspo Q4H prn pain
Percocet- 5mg Codeine/325mg Acetaminophen 1-2Tabs po Q4H prn pain
Dilaudid- 2mg 1-2Tabs po Q4H prn pain
Education:
Afterbirth Pains
Remember that uterus was about fist-size before pregnancy and grew to fit the baby. Now it’s cramping back down to it’s normal size.
It is to be expected to have these contractions for a few days to a couple wks |
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Term
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Definition
Inspect for signs and symptoms of thrombophlebitis, Homan’s Sign (+/-)
Palpate for localized areas of redness, edema and tenderness
Palpate pedal pulses
C/S MUST wear PCS while on bedrest
Education: Ambulate! |
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Term
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Definition
Rubin’s Phases:
Taking-In Phase- 1-2d
Mom focused on her own needs: food, fluid, sleep.
Mother passive.
#1 task Realizing the birth is now a REALITY.
Taking-Hold Phase- 2-10d
- Mom becomes more independent.
- Mom may get anxious re: her competence in caring for infant
Letting-Go Phase
- Letting go of previous role as a childless couple and now not as care free
- Letting go of idealized birth experience |
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Term
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Definition
Postpartum Blues
Affects 70-80% of U.S. women
Starts 3-4d pp, peaks at 4th -5th day, usually resolves within 2 weeks.
S/Sx: fatigue, tearfulness, mood instability, anxiety, insomnia
Cause: Unknown. Likely hormone fluctuations
Postpartum blues is normal (commnon) but not good
If tit asts more than 2 weeks
-seen within days or within first year
-Incidence: 1 of 5 new moms
-S/SX: frequent sadness &/or crying, lack of feelings for baby, feelings of inadequacy, guilt, or shame |
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Term
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Definition
- peaks within first three wks after childbirth
- Incidence: 1-3/1,000 pp women
- S/SX: hallucinations, delusions, agitation, suicidal, severe insomnia |
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Term
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Definition
- Incidence: 2-3% of pp women
- S/SX: intrusive, repetitive and persistent thoughts which tend to focus on baby |
|
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Term
| postpartum anxiety or panic disorder |
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Definition
Postpartum Anxiety &/or Panic Disorder
- Incidence: 4-6% of postpartum women
- Onset first few days postpartum or within first year of delivery
- S/SX: trouble concentrating and remembering, difficulty relaxing, insomnia, panic attacks, overwhelming anxiety |
|
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Term
| screening methods for PP depression |
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Definition
PP Depression Predictors Inventory (PDPI)
Edinburgh Postnatal Depression Scale (EPDS)
- 10 questions r/t mood, anxiety, guilt, SI
Postpartum Depression Screening Scale (PDSS)
- 35 items that cover 7 dimensions: sleeping, eating disturbances, anxiety, emotional liability, mental confusion, loss of self, guilt, SI
Depression Anxiety Stress Scales (DASS-21) |
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Term
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Definition
Assess family support:
Ask (with partner/family outside the rm):
- Who do you live with?
- Are you safe at home?
- Who will be able to help you at home?
- Do you have supplies for you and the
baby? Car seat/Diapers/Formula/Crib/Clothes
Communicate findings or concerns with OB/Peds/Social Worker |
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Term
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Definition
Bonding vs Attachment:
Bonding: UNIdirectional, from parent to child. First 30-60min after birth “sensitive period.” Delay Vit K, erythro ointment?
Attachment: INTERACTION btwn parent & child, reciprocal, +feedback
Assess how mother is interacting with infant.
May be affected by: Baby in NICU, Mom in pain &/or exhausted, OB emergency |
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Term
| importance of handwashing at discharge |
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Definition
1. Prevention of Infection
HANDWASHING! Make sure you wash your hands before holding and feeding your infant and after every diaper change
HANDWASHING! Make sure all visitors wash their hands prior to holding infant |
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Term
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Definition
Have friends and family with cold, cough, strep throat, pink eye or skin infection (cold sore on the lips- which is Herpes simplex virus type 1) stay home and should really avoid mom and baby
2. REST
Tough to get at the hospital, but MUCH NEEDED. Visitors can visit at home in a few days.
Lack of rest may lead to fatigue (physiologic and psychologic)
DON’T TURN AWAY HELP
Lactation suppression:
If not breastfeeding, still may lactate
Encourage well-supporting/tight bra
Apply ice to breast
Do not massage or pump breast- this will stimulate more milk production
Shower with back to the falling water
If Breastfeeding:
Review positioning, feeding frequency, nipple care, stages of milk, pumping, milk storage, bottle introduction
s/s to report to peds (poor feedings, low output)/OB (painful, reddened breasts, feverMastitis)
Ensure she has Lactation Support phone numbers (Warm Line @HUP)
If breastfeeding and want to introduce bottle – after 3-5 weeks postpartum
Perineal Care:
Continue topicals and sitz bath use
Continue peri bottle use
Pat dry
NOTHING in VAGINA x 6wks
Wipe front to back
Thorough hand washing
5. Kegel Exercises
Strengthen pubococcygeal muscles to prevent urinary incontinence
Contract muscles around vagina (as if stopping flow of urine), hold for 10 seconds and relax for 10 seconds
6. Exercises
Postpartum exercises/strengthening (Figure 17-11; pgs. 416-417)
C-Section pts should follow MD instructions after pp visit. Encourage walking.
Prevent back strains: limit bending and leaning forward
7. Diet
Advise to select food that will provide adequate calories that is sufficient for providing energy to sustain mom in caring for a newborn
Need to refer families without adequate food supply to govt.-sponsored programs (WIC, TANF)
Caloric requirements:
1,800 – 2,000 kcal/day moderately active, non-pregnant, non-lactating woman
vs
2,300 – 2,500 kcal/day for breastfeeding women
Iron: 15mg/day
Supplementation recommended if:
- increased blood loss during delivery
- interval between pregnancies < 2yrs
- low Hgb/HCT |
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Term
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Definition
Best sources
for Iron:
beef liver, figs,
spinach, tofu,
watermelon,
potatoes w/ skin dried fruits, oysters |
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Term
| calcium dischagre instructions |
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Definition
Calcium: 19 - 50yo: 1,000 mg/day
Teenager: 1,300 mg/day
Transient bone loss during lactation
Likely not able to get Ca++ from diet
Best source: low fat yogurt, skim milk, cheddar cheese, sardines, salmon, collard greens, spinach, kale, beets |
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Term
| weightloss discharge instructions |
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Definition
Weight Loss
Goal: GRADUAL weight loss
AVOID severe calorie restriction
- Recommended wt loss is 4.5 lbs/month
Caloric intake should not fall below 1,800kcal/day
Excess wt gain that persist after pregnancy may be r/t to obesity later in life
Recommend balanced, low-fat diet filled with protein, complex carbs, fruits/veggies and vitamins |
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Term
| report to NP/midwife/provider if following symptoms come up after leaving hospital |
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Definition
REPORT TO YOUR MD/NP/MIDWIFE:
Fever >100.4
Redness, swelling, pain in breast
Abdominal tenderness (more than cramping pain) not relieved with pain meds
Pelvic fullness or pressure
Perineal pain
Increased bleeding, passing clots, foul smelling odor
Redness, tenderness, swelling in legs
Swelling, redness, separation, drainage from abdominal incision |
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Term
| contraceptive counseling postpartum |
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Definition
CONTRACEPTIVE COUNSELING:
May resume intercourse after MD clearance~about 4-6wks. postpartum
First ovulation in non-lactating women occurs ~45d pp… 1st menses 7-9wks pp (Blackburn, 2003)
Breastfeeding MAY suppress ovulation
Start BC prior to resumption of intercourse |
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Term
| answering the unasked questions |
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Definition
Lack of sexual desire for woman and man is common and NORMAL after childbirth
Effects of Breastfeeding
Estrogen decrease during breastfeeding
May decrease vaginal lubrication
Discomfort due to lacerations/episiotomy |
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