Post partum

Question 1

Birth weight

Answer 1

females born weighing about 5 pounds have:

• 23% higher risk of heart disease
• 80% freater risk of type II diabetes (insulin resistance)
• lower incidence of breast cancer

Question 2

Early mother-infant contact and Baby’s cry

Answer 2

Early contact = bonding (“smell bonding”)

Baby’s cry

• indicator of health status
• respiratory benefits: also stress of delivery increases surfactant, cortisol, and epinephrine –> C-sections decreases stress : respiratory difficulties
• demand for care

Question 3

Neonatal screening

Answer 3

Phenylketonuria = lack enzyne to break down AAA phenylalanine in proteins

Galactosemia = lack enzyme to digest galactose (milk sugar)

Biotinidase deficiency = decreases vit availability - affects function of multiple enzymes used in nutrient metabolism

Sickle cell disease = blood disorder: RBCs

Congenital hypothyroidism = low thyroid hormone levels

Congenital adrenal hyperplasia = lack enzyme to make adrenal gland hormones - cortisol, aldosterone, androgens

Question 4

SIDS

Answer 4

Increased risk factors

• smoking during pregnancy
• preterm delivery
• low birth weight
• multiple birth
• type B blood
• amniotic fluid bacterial infection
• drugs and alcohol during pregnancy
• maternal anemia
• crowded living conditions
• high room temp
• bottle fed > breast fed
• high thyroid hormone levels
• abnormal heartbeats
• genetic defect in protein carrier for serotonin

DONT LET BABY SLEEP ON STOMACH

Question 5

Post partum pelvic pain

Answer 5

Normal: relaxin hormone effects during pregnancy

• allowed for excess widening of pelvis during delivery (2-3 mm)
• instability and pain (symphysis pubis dysfunction)
• goes away pretty quickly

Not normal: diastasis symphysis pubis (rare and painful)

• joint separation without fracture: excess lateral and anterior movements
• widen > 10 mm
• forceps delivery
• symphysiotomy - cut joint for delivery
• treatment = belt supports and physical therapy
• may take months for improvement

Question 6

Physical changes after delivery

Answer 6

Peeing

• fluid tetention = increase in frequency of urination
• induced blood volume/cardiac output returns to normal

Breathing
-lung capacity returns to normal, so breathing gets easier

Question 7

Reproductive organ changes: uterus

Answer 7

Uterus

• returns to original size
• “after pains” = strong uterine contractions that’re enhanced with nursing (oxytocin)
• healing at placental site (6 weeks) –> less time for general endometrium normalcy
• cervical os shrinks (4 weeks)

Question 8

Reproductive organ changes: vagina

Answer 8

discharge - lochia (1 month) (heals placental site and rids excess fluid and blood from uterine lining)

• Lochia rubra = Heavy red flow with clots until day 4
• Lochia serosa = pinkish, brown with less blood, more discharge, and fewer clots –> day 4 to 10
• Lochia alba = yellow/white with little blood, some discharge and no clots –> days 10 to 42

decreases in size and rugae return

Question 9

Psychological changes

Answer 9

Baby blues (67%)

• several days
• exhaustion
• realization of responsibilities with or without a mate
• sadness, anxiety, tearfulness, withdrawal

Post partum depression

• months
• negative effects on bonding with baby
• prior history of depression
• lack of support
• high stress
• cigarette smoking
• doesn’t breast feed