Postnatal

Question 1

What are the postnatal maternal assessments (head to toe - 7 B’s)?

Answer 1

Brain - emotional wellbeing, support, exercise, sleeping, eating and drinking
Breasts - nipples, feeding, latching
Belly - palpation of fungus Blood - lochia
Bottom - perineum or c/s wound, healing, pain, bladder, bowels
Boots - swelling in the legs
Baby - fetal assessment

Question 2

What is included in the top to toe baby assessment (daily)

Answer 2

Behaviour - sleeping, activity, irritability, responsiveness, tone
Feeding - frequency, duration, effectiveness (e.g. weight, output reflecting input)
Output - urine, no. of wet nappies
Stool - no. of dirty nappies, colour
Skin - clear, colour, rashes, birthmarks

Question 3

What is puerperium?

Answer 3

6 - 8 weeks following the birth when the woman’s body adapts to a non-pregnant state

Question 4

What is the involution of the uterus?

Answer 4

Normal involution of uterus with the uterus contracting back to pre pregnancy size (similar) behind pubic bone

Question 5

What are the three phases of involution?

Answer 5

Ischaemia – when muscles of the uterus contract and retract at the third stage of labour. No more blood flow can cause after pains
Autolysis – “cleaning up process”. Myometrium cells reduced in site
Phagytocys – fibrous and elastic tissue. Never quite returns
(Process facilitated by release of oxytocin from the posterior pituitary)

Question 6

What is the fundus?

Answer 6

The top part of the uterus that is across from the cervix

Question 7

What happens in the process of involution?

Answer 7

• Reproductive organs return towards non-pregnant state
• Immediately after birth of the placenta uterus goes to halfway between umbilicus and symphysis – over next 12 hours fundus returns to umbilicus
• Height decreases approximately 1cm daily

Question 8

Day by day progress of the fundus/uterus post birth

Answer 8

Uterus weight at birth = 1kg
One week = 500gms / 5cm above the symphysis pubis
10th day = 60 - 80gms / returned to prep regnant anteverted and anteflexed position
6 - 7 weeks = placental site has healed

Question 9

What are maternal after pains?

Answer 9

The uterus contracting to return to pre-pregnancy size, common during breastfeeding due to oxytocin release

Question 10

Postpartum effects on the genital track (timeframe changes)

Answer 10

3 days post birth = cervix returns to normal consistency
10 days post birth = cervical is 1cm wide
6 weeks = cervical os a slit

Question 11

What is lochia?

Answer 11

Postpartum vaginal discharge /loss (blood mixed with other things)

Question 12

Types of lochia/time-frame

Answer 12

• Completed 2 -3 weeks post birth
• Rubra (red) 1 – 3 days:
• Serosa (pink) 4 – 10 days
• Alba (white) 11 – 21 days

Question 13

How long long should a woman breastfeed after birth?

Answer 13

Uninterrupted for at least 60 minutes

Question 14

What are the benefits of breastfeeding for the baby?

Answer 14

Lower risk of gastroenteritis, respiratory infections, SIDS, Obesity, type 1 & 2 diabetes, allergies (Asthma)

Question 15

What are the benefits of breastfeeding for the mother?

Answer 15

Greater protection against breast and ovarian cancer and hip fractures later in life

Question 16

What are the benefits of skin to skin?

Answer 16

reduces crying, keeps baby warmer, cardiorespiratory stability, improves bonding, more likely to breastfeed, more likely to breastfeed for longer

Question 17

What are some hunger cues from the baby?

Answer 17

quiet alertness, stretching out, rooting, sucking sounds, tongue in and out, rapid eye movements, hand to mouth movements, crying last late sign

Question 18

What should you observe for in a feed?

Answer 18

The position of baby to breast and mother’s body (stomach to stomach), rooting, gape, position of nipple to baby (line nose up with nipple), wide latch, swallowing signs

Question 19

What are the signs of effective attachment in breastfeeding?

Answer 19

wide open mouth, chin indenting breast, lips curled out, full cheeks, sounds of swallowing, comfortable for mother, milk transfer

Question 20

What is the minimum amount of times a newborn baby should be feed?

Answer 20

At least 8 feeds in 24 hours (3 hourly)

Question 21

How does input of milk affect baby output (stool/urine)?

Answer 21

Babies that feed more will have more wet/dirty nappies and vice versa if they are not feeding enough. The colour of stool will also change colour more quickly from meconium when feeding well.

Question 22

What are the types of stool and when should they occur?

Answer 22

Meconium – 1 – 2/3 days
Transitional/Green – day 3 – 4/5
Yellow – day 4 onwards
Urates in urine – orange/red spots in urine

Question 23

In what time frame should babies pass urine and meconium?

Answer 23

Within 36 hours of birth. If longer, must be referred.

Question 24

What are the newborn weight loss ranges and what do they mean/

Answer 24

Normal range - <7%
Requires evaluation and plan (typically breastfeeding plan) - Between 7 - 10%
Requires evaluation, plan and referral - >10%

Question 25

How to calculate birth weight loss?

Answer 25

Weight loss X 100 = %
Birth weight 1

10% of birth weight can be calculated by removing a zero from birth weight e.g. birth weight = 3500g, 350g is 10% lost

Question 26

How many postnatal visits to the mother must a midwife do?

Answer 26

At least 7 PN visits and maternal check with 24 hours of birth

Question 27

When does the detailed baby exam take place?

Answer 27

Must be done within 24 hours of birth, again within 7 days (usually day 5), again at final visit