Maternal Midterms Reviewer 1.1 PDF

WEEK 7 PASSENGER Nursing care of a family during labor and birth. -the fetus is the passenger -head is the widest part I. Definition of Labor:...

WEEK 7 PASSENGER Nursing care of a family during labor and birth. -the fetus is the passenger -head is the widest part I. Definition of Labor: -the cranium, the upper most portion of the skull, is >are the series of events by which uterine contractions and composed of eight bone. abdominal pressure expel a fetus and placenta from the -frontal, occipital, 2 parietal uterus -sphenoid, ethnoid and 2 temporal bones. II. Theories of Labor modling-overlapping of skull bones along the suture lines, > Labor usually begins between 37 and 42 weeks of which causes a change in the shape of the fetal skull to one pregnancy, when a fetus sufficiently mature to adapt to long and narrow. extra uterine life, yet not too large to cause mechanical difficulty with birth Fetal attitude describes the position of specific parts of a 1.The uterine muscle stretches from the increasing size of fetus’s body. EL the fetus, which results in release of prostaglandins -Degree of flexion a fetus assumes during labor. 2.The fetus presses on the cervix, which stimulates the The ideal fetal attitude is when the fetus has its: release of oxytocin from the posterior pituitary Chin tucked into its chest. 3. Oxytocin stimulation works together with prostaglandins Arms and legs drawn into the center of its chest. GU to initiate contractions But, there can be times the fetal attitude is irregular. For 4.Changes in the ratio of estrogen to progesterone occurs, example, its chin is tilted back instead of tucked increasing estrogen in relation to progesterone, which is interpreted as progesterone withdrawal MI 5. The placenta reaches a set age, which triggers contractions 6. Rising fetal cortisol levels reduce progesterone formation and increase prostaglandin formation 7. The fetal membrane begins to produce prostaglandins, L. which stimulate contractions III. The Components of Labor N 1.The passage Refers to the route a fetus must travel from the uterus YA through the cervix and vagina to the external perineum Known as the woman’s pelvis Should be of adequate size and contour 2. The passenger (the fetus) BR Fetal lie describes how the fetus’s spine lines up with its Should be of appropriate size and in an advantageous birth parent’s spine. Ideally, they line up vertically because position and presentation the fetus’s head is down in the birth canal. The body part of the fetus that has the widest diameter is This is called longitudinal lie. If the fetus is sideways or the head horizontally across the uterus, it’s in a transverse lie. 3. The powers of labor (uterine contractions) are adequate ICK 4. The psyche, or a woman’s psychological state which may either encourage or inhibit labor. > This can be based on her past life experiences as well as TR her present psychological state IV. Difference Between True and False Contraction FALSE CONTRACT TRUE CONTRACT FETAL PRESENTATION PA Begin & remain irregular begin irregular but become -Fetal presentation denotes the body part that will first regular & predictable contact to the cervix or to be born first and is determined Felt first abdominally >felt first in lower back and by the combination of fetal lie and the degree of fetal and remain confined to the sweep @ the abdomen in flexion. abdomen and groin a wave -Normally, the presentation is vertex (head first), and the Often disappear with > Continue no matter what position is occiput anterior (facing toward the pregnant ambulation and sleep the woman’s level of person's spine) and with the face and body angled to one activity side and the neck flexed. Do not increase in > Increase in duration, duration, frequency & frequency and intensity intensity  Mechanisms (Cardinal Movements) of Labor V. Mechanisms (Cardinal Movements) of Labor ENGAGEMENT-settling of the presenting part of a fetus far enough into the pelvis that rests at the level of the ischial spines, the midpoint of the pelvis. 1.Descent >The downward movement of the biparietal diameter of the fetal head within the pelvic inlet. Nulliparas: descent occurs during 2nd stage Multiparas: descent usually begins with engagement Occurs due to : 1.Pressure of amniotic fluid EL 2.Direct pressure on the breech by the fundus during contractions 3. Bearing-down of maternal abdominal muscles GU 2.Flexion As descent is completed, and the fetal head touches the pelvic floor, the head bends forward onto the chest, causing Fetal position the smallest anteroposterior diameter -the relationship of the presenting part to a specific MI Due to resistance from the cervix, pelvic walls, or pelvic quadrant and the side of the pregnant persons pelvis. floor 4 quadrant Chin is brought towards the chest 1.Rigth anterior Shifts from longer occipitofrontal 2.Left anterior diameter (12cm) to shorter L. 3.Rigth posterior Suboccipito bregmatic diameter (9.5cm 4.Left posterior vertex presentation-occiput 3. Internal Rotation Face presentation- chin or mentum N As the head flexes at the end of descent, the occiput rotates Breech presentation- sacrum so the head is brought into the relationship to the outlet of Shoulder presentation- scapula or the acromion process. YA the pelvis. This movement brings the shoulders, coming next into the optimal position to enter the inlet BR 4.Extension > As the occiput of the fetal head is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head >The head extends and the foremost parts of the head, the ICK face and chin are born. 5. External Rotation -almost immediately after the head of the infant is born, TR the head rotates a final time back to the diagonal or transverse position of the early part of labor. -the anterior shoulder is born first, assisted perhaps by downward flexion of the infants head. PA 6. Expulsion Mechanisms (Cardinal Movements) of Labor -once shoulder are born, the rest of the baby is born easily and smoothly because of its smaller size. -the end of the pelvic division of labor. Cervical Changes a. Effacement Is shortening and thinning of the cervical canal All during pregnancy, the canal is approx. 1-2 cm long During labor, the longitudinal traction from the contracting c. The Transition Phase uterus shortens the cervix so much that the cervix virtually Contraction reach their peak of intensity; every 2-3 disappears minutes with a duration of 60 to 70 seconds and a b. Dilatation maximum cervical dilatation of 8 to 10 cm > Refers to the enlargement or widening of the cervical Woman is experiencing an intense discomfort that canal from an opening a few millimeters wide to one large is so strong enough (approx.10cm) May accompanied with nausea and vomiting With loss of control, anxiety, panic or irritability Effacement means that the cervix stretches and gets The irresistible urge to push usually begins thinner. Dilatation means that the cervix opens. 2. The Second Stage > As labor nears, the cervix may start to thin or stretch The time span from full dilatation and cervical (efface) and open (dilate). effacement to birth of the infant EL >This prepares the cervix for the baby to pass through the A woman typically feels contractions change from birth canal (vagina). the char. of crescendo-decrescendo pattern to an uncontrollable urge to push VI. The Stages of Labor As the fetal head pushes against the vaginal GU The first stage of dilatation, which begins with the introitus, this opens and the fetal scalp appears at initiation of true labor contractions and ends when the opening to the vagina and enlarges from the the cervix is fully dilated size of a dime, to a quarter, then a half-dollar The second stage, extending from the time of full This is termed as “crowning” MI dilatation until the infant is born The third or placental stage, lasting from the time 3. The Third Stage the infant is born until after the delivery of the Known as the placental stage placenta Begins with birth of the infant and ends with the The first 1-4 hours after birth of the placenta is L. delivery of the placenta sometimes termed as the “fourth stage” to After the birth of an infant, the uterus can be emphasize the importance of close maternal palpated as a firm, rounded mass just below the observation needed at this time level of the umbilicus N After a few minutes of rest, uterine contractions First Stage begin again and the organ assumes a discoid shape YA Begins with the initiation of true labor contractions and It retains this new shape until the placenta has ends when the cervix is fully dilated separated, aprroximately 5 minutes after the birth Takes about 12 hours to complete and divided into three of the infant. segments: BR II. TWO PHASES INVOLVED a. Latent Phase 1.Placental separation Also known as the early phase begins at the onset of 2.Placental expulsion regularly perceived uterine contractions and ends when SIGNS OF PLACENTAL SEPARATION rapid cervical dilatation begins > Placing a clamp on the cord near the perineum makes it ICK Contractions are mild and short lasting - 20 to 40 sec. easier to appreciate this lengthening Cervical effacement occurs and the cervix dilates minimally 1.Lengthening of the umbilical cord 2.Sudden gush of blood from the vagina b. The Active Phase 3.Placenta is visible at the vaginal opening TR Cervical dilatation occurs more rapidly 4. Uterus contracts and feels firm again Contractions grow stronger, lasting 40-60 sec and occur PLACENTAL EXPULSION approx. every 3 to 5 minutes The fetal side of the placenta is shiny because of the Show (increased vaginal secretions) and spontaneous apposed amniotic membrane (Schultze mechanism) PA rupture of the membranes may occur The maternal side of the placenta is dull and is subdivided into as many as 35 lobes (Duncan mechanism) c. The Transition Phase > Contractions reach their peak of intensity, occurring every PUERPERIUM-KNOWN AS THE POSTPARTAL PERIOD 2 to 3 minutes With a duration of 60 to 70 sec. –REFERS TO THE 6-WEEK PERIOD AFTER CHILDBIRTH Nursing Management: FOURTH STAGE Encourage woman to be active participant by PSYCHE-EMOTIONAL STATE DURING BIRTH keeping active and assuming whatever position is This aspect refers to supporting the pregnant client’s most comfortable for her during this time psychological adaptation to labor. Lying flat on her back should be avoided during Ways to support birthing clients with their frame of mind this time during labor include: Education: childbirth classes, anticipatory guidance during labor 3. Late Decelerations Labor support: Continuous labor support increases vaginal Decelerations that are delayed after the onset of birth rate. Build trust, frame labor pain as meaningful and contractions productive, guide clients to their own decisions. that suggest decreased blood flow to the uterus Client-centered support: Respect cultural differences, gradual decrease in the fetal heart rate typically following respect client autonomy, and communicate effectively. the uterine contraction Maternal Danger Signs of Labor Causes: 1.High or Low BP a. uteroplacental insuffiency ( not enough oxygen to the A systolic pressure > 140mmHg & a diastolic pressure > baby), 90mmHg or an increase in systolic pressure > 30mmHg or in b. amniotic fluid infection which can occur due to the diastolic pressure of > than 15mmHg (the basic criteria excessively EL for gestational hypertension) should be reported long labor after the water has been broken Falling BP should also be reported because it may be a sign c. low maternal blood pressure of intrauterine hemorrhage Others signs: apprehension, increased PR and pallor- 4. Prolonged Decelerations GU hypovolemic shock ⮚ Decelerations that are a decrease from the FHR baseline of 15 beats per minute or more and last 2.Abnormal Pulse longer than 2 to 3 minutes but less than 10 Most women during pregnancy has a PR of 70-80 beats per minutes. MI minute 5. Variable Decelerations Usually increased during the second stage of labor because Decelerations that occur at unpredictable times in of the exertion relation to contractions that indicate compression of the PR > 100 beats per minute during labor is unusual- umbilical cord indication of hemorrhage 6. The sinusoidal pattern L. 3. Inadequate or prolonged Contractions ⮚ In a fetus that is severely anemic or hypoxic, 4.Abnormal Lower Abdominal Contour central nervous system control of heart pacing may > Full bladder is dangerous: be so impaired that the FHR pattern resembles a N 1.Bladder may be injured by the pressure of the fetal head smooth, frequently undulating wave with a cycle 2.Pressure of the full bladder may not allow the fetal head frequency of 3 to 5 per minute and persisting 20 YA to descend minutes or more. Nsg Mgt: Urge woman to void every 2 hours during labor 5. Increasing Apprehension Fetal Danger Signs of Labor WEEK 8 BR 1.Meconium Staining The nursing role in providing comfort during labor and birth Green color in the amniotic fluid reveals the fetus has had a loss of rectal sphincter control, allowing meconium to pass I.Methods of Pain Management into the amniotic fluid 1.The Bradley (Partner-Coached) Method May indicate fetal hypoxia which stimulates the vagal reflex >Stresses the important role of a woman’s partner during ICK and leads to increased bowel motility. pregnancy, labor, and the early newborn period 2.High or Low FHR > During pregnancy, the woman performs muscle toning 3. Hyperactivity exercises and limits or omits foods rich in preservatives, > Sign of fetal hypoxia animal fat ,or salty foods. TR 4.Low O2 saturation >The woman is encouraged to walk during labor > Normal O2 saturation is 40% to 70% 2.The Psychosexual(Kitzinger) Method >Includes conscious relaxation and levels of progressive Fetal Heart Rate Patterns breathing that encourages a woman to “flow with” uterine PA 1. Accelerations contractions > Normal increases in FHR caused by fetal movement, a 3.The Dick-ReadMethod change in maternal position or administration of an >Premise is “fear leads to tension, tension leads to pain” analgesic. > Achieved through education and focus on abdominal 2. Deceleration breathing during contractions > Normal decreases in FHR resulting from pressure on the fetal 4.TheLamazeMethod head during contractions ØBased on the “gating theory of pain control” > a transient decrease in heart rate that coincides with the >Through stimulation response conditioning, women can onset learn to use controlled breathing to reduce pain during of a uterine contraction, resulting in vagal stimulation and labor slowing of the heart rate. > Also termed as psycho prophylactic method because it Comfort and Non pharmacologic Pain Relief Measures focuses on preventing pain in labor 1.Doula > A woman who is experienced in childbirth and Six major Concepts postpartum support 1.Labor should begin on its own, not be induced > Provides physical, emotional and informational support 2.Women should walk, move around and change positions prenatally, throughout labor during labor and birth and even at home in the postnatal 3.Women should bring a loved one, friend or doula for period continuous support. 2. Relaxation 4. Interventions that are not medically necessary should be 3.Focusing and imagery avoided. 4. Breathing Techniques 5. Women should be allowed to give birth in other positions 6. Herbal Preparations than on their back and should follow their body’s urges to 7. Aromatherapy and essential oils EL push 8. Heat or Cold Application 6. Mother and baby should be kept together after birth , it Heat and cold can help some women during labor. is best for the mother, the baby and for breastfeeding Heat can help the muscles relax, and both heat and cold can act as a nerve distractor because it GU Doula-a woman, typically without formal obstetric training, provides a new sensation, which can reduce the who is employed to provide guidance and support to a perception of pain. pregnant woman during labor. 9. Bathing or Hydrotherapy is immersion in warm water during labor. MI 5.Conscious relaxation - RELAXING BODY PARTS It can be used during any part of labor, including 6.BREATHING EXERCISES early labor and active labor, as well as the late a. Cleansing breath (“pushing”) phase. >Breathing in deeply and exhaling deeply Hydrotherapy is offered as a comfort measure, b. Consciously controlled breathing L. providing relaxation and pain relief. >Set breathing patterns at specific rates, provides 10. Therapeutic Touch and Massage distraction as well as prevents the diaphragm from Studies have shown that massage therapy performed descending fully and putting pressure on the expanding during labor can significantly reduce pain. N uterus. Benefits: a. Releases Endorphins. YA LEVEL 1:slow deep chest breathing of comfortable but full Pregnancy massage stimulates the body’s release of respirations at a rate of 6-12 breaths per min endorphins, which are chemicals produced by the pituitary > Used for cervical dilatation: 0 and 3 cm gland. LEVEL 2: lighter and more rapid breathing, rib cage expands These act as a natural painkillers and provide welcome BR but be so light that the diaphragm barely moves relief from labor pain, stimulating a positive outlook on the Ørate: up to 40 breaths/min whole experience. ØCervical dilatation : 4 and 6 cm b. Regulates Hormones LEVEL 3: more shallow and more rapid breathing Another of the benefits of pregnancy massage is that it Ørate:50 to 70 breaths/min produces and regulates neurohormones that make the ICK ØRespirations are faster but exhalation must be a little labor experience less painful. stronger to allow good air exchange and to prevent Scientific evidence backs up the claims that it raises the hypoventilation levels of happy-brain chemicals while lowering ØWoman should say “out” with each exhalation stress-producing chemicals. TR ØCervical dilatation:7 and 10 cm c. Relaxes Muscles LEVEL 4: effective for transition contractions Labour raises anxiety levels. Even people who have never, >“PANT BLOW” pattern , or taking three or four quick or will never, experience labor, have some fear or anxiety breaths (in and out) then a force full exhalation surrounding it. PA >Sounds like a train sound: breath-breath-breath-huff, and So naturally, when you are actually going through it, you are sometimes referred to as “choo-choo” or going to feel all kinds of emotions. Labor is very much the “hee-hee-hee-hoo” breathing rollercoaster woman describe it as being. LEVEL 5: continuous, very shallow panting at about 60 d.Decreases the need for medical intervention breaths/minute Research has shown that mothers who go through > Can be used for very strong contractions or during the massage therapy are less likely to require second stage of labor to prevent the woman from pushing medicinal in the course of labor because massage before full dilatation triggers the natural body processes required for a smooth childbirth experience. When conducted by an experienced therapist, this type of massage stimulates contractions. That  reduces the need an epidural or any other drug 2.The Cervix associated with labor induction. Immediately after birth – feels soft and malleable to palpation Internal and external os- open 11. Yoga and Meditation End of 7 days- the external os narrowed to the size of a > can improve the outcomes of pregnancy and childbirth. pencil opening, feels firm and nongravid again They can be used as part of the care protocol along with 3.The vagina childbirth preparation classes to reduce the complications After vaginal birth- feels soft, with few rugae,its diameter is of pregnancy and childbirth. greater than normal Hymen is permanently torn with small separate tags of 12. Reflexology tissue Reflexology techniques to stimulate the uterus and ovary Takes the entire postpartal period for the vagina to involute reflexes as well the production of Oxytocin to help bring on (by contraction, as with the uterus) until it gradually returns EL labor naturally. to its prepregnancy state. A woman who is breastfeeding may have delayed ovulation 13. Hypnosis and may continue to have thin-walled or fragile cells that > Hypnobirthing is a birthing method that uses self-hypnosis cause slight vaginal bleeding during sexual intercourse until GU and relaxation techniques to help a woman feel physically, about 6 weeks mentally and spiritually prepared and reduce her awareness Advice the woman to practice kegel exercise – to strengthen of fear, anxiety and pain during childbirth. the tone of the vagina MI 14. Biofeedback 4. The Perineum -based on the belief that people have control over Immediately after birth – edematous and tender due to the and can regulate internal events such as heart rate and great amount of pressure experienced during birth pain responses. Eccymosis patches from ruptures capillaries on the surface Labia majora and labia minora remain atrophic and L. 15. Transcutaneous electrical nerve stimulation softened after birth and never return to its prepregnancy -works to relieve pain by applying counterirritation state to nociceptors. Advice the woman non pharmacologic comfort measures: N cold compress within 24H after birth 16. Acupuncture and acupressure warm compress after 24 H after birth YA -a form of complementary medicine that involves May sit on a soft pillow or doughnut pad pricking the skin or tissues with needles, used to alleviate Pharmacologic pain relievers as prescribed by the doctor: pain and to treat various physical, mental, and emotional acetaminophen, ibuprofen. conditions. BR -the application of pressure on specific points on b.Systemic Changes the body to control symptoms 1.The Hormonal System Decrease in pregnancy hormone as soon as the placenta is PHARMACOLOGIC MEASURES FOR PAIN RELIEF DURING no longer present LABOR *HCG and hPL-almost negligible by 24Hrs ICK 1. ANALGESIA- reduces or decreases awareness of pain By week 1 – progestin, estrogen and estradiol are all at 2. ANESTHESIA- causes partial or complete loss of the prepregnancy levels (estriol may take an additional week pain sensation. before it reaches prepregnancy levels) FSH (Follicle Stimulating Hormone) remains low for about TR III.PHYSIOLOGIC CHANGES OF THE POSPARTAL PERIOD 12 days and begin to rise as a new menstrual cycle is Reproductive System Changes/Local Changes initiated 1.Uterus-Uterine involution Immediately after birth- wt: 1,000g 2.The Urinary System PA At the end of the 1st week- wt: 500 g During pregnancy- 2,000-3,000ml of excess fluid Time involution is complete (6 weeks)- wt: 50g accumulates in the body so extensive diaphoresis (excessive The uterus of a breastfeeding mother may contract more sweating) and diuresis (excess urine production) begin quickly because oxytocin stimulates uterine contractions almost immediately after birth to rid the body of this fluid. Consistency of the post partal uterus- well contracted Daily urine output-from a normal level of 1,500 to as much fundus feels so firm as 3,000ml/day during the 2nd to 5th day after birth If soft and boggy in the first hour after delivery-uterine This marked increase in urine production causes the atony-post partum bleeding bladder to fill rapidly. Nursing Mgt:check the bladder, massage the uterus, apply Advice: cold compress over the abdomen, Check the vital signs, ✔ reassure the mother that this is normal administer Oxygen, notify the physician.  ✔ Instruct the mother to continue to drink a healthy Modified sit-ups to strengthen abdominal muscles and amount of fluids daily especially if she is return abdominal support to its prepregnancy level breastfeeding Surgery may be required to correct diastasis recti There is a transient loss of tone together with the edema 5.The Gastrointestinal System surrounding the urethra due to the pressure from the fetal Digestion and absorption begin to be active again soon head as it passed on the bladder’s underside after delivery unless the woman has had a cesarean This leads to decreased woman’s ability to sense when she delivery has to void Hemorrhoids (distended rectal vein) that has been pushed A woman who has had an epidural anesthesia can feel no of the rectum during pregnancy may be present sensation in the bladder area until the anesthetic has worn Bowel sounds are active but passage of stool may be slow off because of the still-present effect of relaxin ( a hormone Management: which softens and lengthens the cervix and pubic EL 1.Asess a woman’s abdomen frequently in the immediate –symphysis for preparation of the infant’s birth postpartal period Management: Method: Palpation: > Advice the woman to eat high fiber diet and increase fluid Findings: a full bladder is felt as a hard or firm area just intake GU above the symphysis pubis Method: Percussion: place one finger flat on the woman’s RETROGRESSIVE CHNAGES OF THE PUERPERIUM abdomen over the bladder and tap it with the middle finger Retrogressive - declining from a better to a worse state of the other hand 1.Exhaustion MI Findings: Experienced by the woman for the last several months of Full bladder- sounds resonant in contrast to the thudding pregnancy” difficulty sleeping sound of non-fluid filled tissue Working hard during labor Results: Experiencing “sleep hunger” this pressure make a woman feel as if she has to void but 2.Weight Loss L. unable to do so Due to rapid diuresis and diaphoresis during the 2nd to 5th Inadequate or lack of contraction days after birth Management: Weight loss of 5 lbs (2 to 4 kg) N > Assist the woman to the bathroom to urinate Due to lochia flow-additional lost of 2 to 3 lb (1 kg) Influenced by the woman’s nutrition, exercise and YA 3.The Circulatory System breastfeeding Presence of reduced blood volume accumulated during 3.If the infant refuses, instruct the mother to pump her pregnancy breasts to maintain flow and to avoid clogged ducts), then Causes offer the affected breast after 12-24 HRs BR Diuresis (excess urine production) between 2nd and 5th day 4.Once the mastistis is treated-infants will resume after birth breastfeeding after 12-24Hrs Blood loss at birth Normal blood loss with vaginal birth – 300-500 ml b. Pulse Cesarean delivery – 500-1,000 ml Usually slower than usual during the postpartal period ICK A 4 point decrease in hematocrit (proportion of RBC to Causes: circulating plasma)and a 1 g decrease in hemoglobin occur During pregnancy- the distended uterus obstructed the per 250 ml of blood lost amount of venous blood returning to the heart If the woman was anemic during pregnancy, she could be After birth- to accommodate the increased blood volume TR expected an anemic afterwards returning to the heart, stroke volume increases that leads Management: advice woman to eat food rich in iron; to reducing the PR between 6-70beats/min. administer iron prep as prescribed By the end of the first week- PR will return to normal During the postpartal period- a rapid and thread pulse PA 4.The Integumentary System could be a sign of hemorrhage After birth – striae gravidarum still appear reddened and may be more prominent c.Blood Pressure White woman – will fade to a pale white over the past 3-6 A decrease may indicate bleeding mos An elevation above 140/90- may indicate postpartal Black woman—may remain slightly darker pigment hypertension melasma/chloasma, linea nigra – become barely detectable Compare the woman’s BP with her prepregnancy level by 6 weeks rather than with standard blood pressure ranges Diastasis recti (overstretching and separation of the Causes: abdominal musculature) – appear as slightly indented Oxytocin administration during the postpartal period-to bluish streak in the abdominal midline achieve uterine contraction, cause contraction of all smooth Management: muscle, including blood vessels These can increase blood pressure Some mothers feel uterine cramps initially when breast Management: feeding until the uterus fully involutes. > Always assess the BP before administering- if Bp > Often when mothers feel their “milk has come in” 140/90mmHg, withhold the medication and notify the (engorgement)-occurs between birth to 5 to 10 days attending physician-to prevent hypertension and possible postpartum; termed as “transitional milk” cerebrovascular accident Orthostatic Hypotension- major complication during LACTOGENESIS III postpartal period occur from day 10 until weaning postpartum Cause: woman lost a considerable amount of blood with When the “mature milk” supply is driven by the circulating birth lactation hormones oxytocin and progesterone Dizziness that occurs on standing because of the lack of adequate blood volume to maintain nourishment of the LACTOGENESIS IV EL brain cells Occurs after complete weaning and the breasts involute to To assess: their prelactation state Check the woman’s BP and PR while she is lying supine Breast milk forms in response to the decrease in estrogen, Raise the head of the bed fully upright and progesterone levels that follows delivery of the GU Wait for 2-3 minutes and recheck the BP and PR placenta If PR is increased > 20beats/min. and BP is < 15 to 20mmHg This stimulates prolactin production and milk production than formerly- woman is positive for and an increase in prolactin and oxytocin Management: Signs and symptoms: breasts become fuller, larger and MI 1.Inform the attending physician firmer as blood and lymph enter the area to contribute fluid 2.Advice the woman to sit up slowly and “dangle” her legs to the formation of milk. on the side of her bed before attempting to stand and walk 3.If with obvious dizziness, support the woman to avoid Breasts distention, engorgement with feeling of heat or falling incident tenderness L. 4.Advice the woman not to attempt to walk while carrying Engorgement phase: the breast tissue appear reddened- her newborn until her cardiovascular status adjusts to her 3rd or 4th day after birth- primary engorgement blood loss. Fades when infant begins effective latching and begins N transferring colostrum followed by milk from the breasts B.PROGRESSIVE CHANGES OF THE PUERPERIUM YA progressive- the building of new tissue Factors that Influence successful Breastfeeding: Requires good nutrition; caution women against strict 1.infant’s successful latch dieting that would limit cell-building ability during the first 2.Ability to suck 6 weeks after childbirth 3.Transfer milk effectively BR 4. Lactation support 1.Lactation 5.Milk supply Driven by hormones from the hypothalamus to the pituitary 6.Emplyment gland in order to secrete the lactation hormones 7.Personal habits This is identified by four phases of lactogenesis (human milk 8.mother’s view about breastfeeding ICK production) A retained placenta inhibit this process by causing continual circulation of progesterone – inhibit prolactin and milk production TR FOUR PHASES: LACTOGENESIS 1 PA – milk synthesis Begins around 16 weeks gestation as the glandular luminal cells in the breast begin to secreting colostrum (thin, watery prelactation secretion) 3.Return of Menstrual Flow After the delivery of the placenta production of placental LACTOGENESIS II estrogen and progesterone ends Triggered at birth by the delivery of the placenta, when the progesterone (prolactin is no longer inhibited) and other Rise in production of FSH circulating pregnancy hormones suddenly decrease and Ovulation oxytocin sharply increases as a result of the infant sucking. Return of Normal Menstrual Cycles Oxytocin helps the uterus to shrink to its pre pregnancy size > woman not breastfeeding – menstrual flow return 6-10 weeks after birth > If breastfeeding- menstrual flow may not return for 3 or 4 If the woman does not have adequate rubella antibody titer months (lactational amenorrhea) and anticipates further pregnancies , she should be asked if she wants a rubella immunization before discharge IV.Psychological Changes During the Post Partal period Women who are Rh negative and who have had an Phases of the Puerperium Rh-positive infant will receive Rh0 (D) immunoglobulin a. Taking-in phase (RhIg) or Rh antibodies to prevent iso immunization 2 to 3 days postpartum concerns in a future pregnancy Woman is dependent and largely passive Inform the parents that many healthcare agencies have a b. Taking-hold phase community liaison person, ideally a nurse, who calls or > 3 days to 2 weeks makes a home visit to women after discharge Woman initiates actions and makes her own decisions This person helps the new mother assess her own health c. Letting-go phase and that of her baby and answers questions from families > Varied time frame who lose their instructions or unable to interpret them after EL > Woman redefines her new role they have returned home. Making telephone calls or visiting a family 24 Hours after Maternal Concerns and Feelings in the Postpartal Period discharge is another way to evaluate whether the family is 1.Abandonment/Feeling overlooked/ forgotten able to continue self-evaluation and infant care GU 2.Disappointment/disillusionment 3.Postpartal Blues 6.Postpartal Examination Check up 4-6 weeks after birth (the end of the postpartal V.Discharge Planning period) MI The greatest need of a postpartal woman before discharge from a hospital is education to prepare her to care for herself and her newborn at home. Areas of Concerns: Review of Post Partum Assessment Areas of Concern Before Discharge Breast: check if the woman is breast feeding- she is free of 1.Rooming In – keeping the infant with the parents nipple pain or damage and has established milk supply L. To make the woman or parents to become acquainted with Abdomen/Uterus: check for tone and determine that the their child uterus involution is complete and the uterus is no longer To make the parents more confident in their ability to care palpable abdominally N for their baby Returning to work or school To form a mother-child relationship Internal Examination-to be certain involution is complete YA and any lacerations sustained during birth have healed. 2.Sibling Visitation Reduces feelings that their mother cares more about the new baby than about them WEEK 9 BR To relieve some of the impact of separation Nursing care for the family in need of reproductive life Help to make the baby a part of the family planning. Check if siblings are free of contagious diseases Have them wash their hands 1.REPRODUCTIVE LIFE PLANNING IDEAL CONTRACEPTIVE SHOULD BE: ICK Areas of concern: Safe, effective 1.How to bathe and breastfeed the baby Compatible with spiritual and cultural beliefs and 2.Care for the infant’s cord and circumcision personal; preferences of both the users and sexual 3.A review of how much infant’s sleep during 24 hours partner TR 4.Inform a woman that she must return to her physician for Free of bothersome side effects an examination 4-6 weeks after birth; take the baby to the Convenient to use and easily obtainable primary care provider for an examination within the first 3 Affordable and needing few instructions for to 5 days postpartum. effective use PA Free of effects on future pregnancies 5.Maternal Immunizations Before a patients begins using a new method of Centers for Disease Control and Prevention (CDG) contraception, information that should be obtained recommend that each pregnant woman receive a Tdap and includes; seasonal influenza vaccine with each pregnancy. Vital signs, PT, and hemoglobin for detection of Tdap – Tetanus, Diptheria & Pertussis anemia Check if this was given prenatally to the women, if not, Papanicolaou pap smear test and STI screening inform her physician and if applicable to be given prior to Obstetric history discharge Subjective assessment Other close caregivers: partners, grandparents are also Sexual practices recommended to be up to date on their Tdap and influenza vaccines Natural Family Planning Abstinence- or refraining from sexual relations -has 0% failure rate and also the most effective way to How to interpret: prevent STI,s (+) ovulation – if a slight dip in temperature followed by an -sex education increase No coitus for the next 3 days (the possible life of the Periodic Abstinence- a method to avoid pregnancy by discharged ovum) avoiding sex on the days conception may be possible. Sperm can survive from 3 to 5 days and rarely as many as 7 days in the female reproductive tract, calendar method and Lactation Amenorrhea Method (LAM) BBT are recommended to be combined -safe birth control method Factors that can affect BBT: Increased temperature might be due to other illness-could Criteria be mistaken as a sign of ovulation-could mistake a fertile An infant is: day with a safe one EL Under 6 months of age Changes in the woman’s schedule Being totally breastfed at least every 4 hours during the day and every 6 hours at night, and Cervical Mucus Method (Billing’s Method) Receiving no supplementary feedings Before ovulation each month- cervical mucus is GU Mother menses has not returned. thick and does not stretch when pulled between the thumb and finger Coitus Interruptus Just before ovulation- mucus secretion increases ⮚ The man withdraws his penis and ejaculates On the day of ovulation – the peak day- becomes MI outside the vagina copious, thin, watery and transparent, feels ⮚ One of the oldest known methods of contraception slippery (like egg white) and stretches at least 1 ⮚ Pre ejaculation inch before the strand breaks A property known as spinnbarkeit POST COITAL DOUCHING all the days the mucus is copious L. -Douching following intercourse, no matter what solution is and for at least 3-4 days afterward- used, is ineffective as a contraceptive measure as sperm considered as fertile days may be present in cervical mucus as quickly as 90seconds N after ejaculation, long before douching could be Symptothermal Method accomplished. Combines the cervical mucus and BBT methods YA Couple abstains from coitus until 3 days after the FERTILITY AWARENESS METHODS rise in temperature or the fourth day after the -Methods rely on detecting when a person will be capable peak of mucus change of impregnation so they can use periods of abstinence They also analyze their cervical mucus everyday BR during that time. and observe for other signs of ovulation such as mittelschmerz (midcycle abdominal pain) or if the Calendar (Rhythm) Method cervix feels softer than usual. Requires a couple to abstain from coitus on the days of a menstrual cycle when the woman is most STANDARD DAYS METHOD: CYCLE BEADS ICK likely to conceive. The woman keeps a diary of about six menstrual cycles To calculate “safe” days, she subtracts 18 from the TR shortest cycle she documented This number predicts her first fertile day. She then subtracts 11 from her longest cycle This represents her last fertile day PA Basal Body Temperature Before the day of ovulation, a woman’s basal body temperature (BBT) falls about 0.5 degrees F At the time of ovulation, her BBT rises a full Fahrenheit degree (0.2 degrees C) due to increase progesterone with ovulation MARQUETTE MODEL Serves as a basis for the BBT This method combines the use of ovulation Procedure: detection with other signs of ovulation( cervical Woman takes her temperature early in the morning before mucus, BBT, cervix position and softness) to avoid getting up from bed and without undertaking any activity pregnancy during the fertile period. Route: oral/tympanic membrane  Develop by nurses and doctors in the late 1990’s at Implanted in a clinic under local anesthetic during Marquette University in Wisconsin. menses or no later than day 7 of a menstrual cycle The Marquette Model brings 21st-century to be certain the woman is not pregnant technology to NFP by using urine fertility Effects: biomarkers collected at home that measure Suppress ovulation, thicken cervical mucus, hormone levels. Change the endometrial lining making implantation difficult These biomarkers can be used in conjunction with cervical mucus or basal body temperature and an Transdermal patch/ ESTROGEN/PROGESTERONE algorithm to confidently determine the woman's The small patch, worn on the skin, releases fertile window. hormones into your bloodstream that thicken The purpose of using natural biological signs of cervical mucus and suppress ovulation. fertility is to help women and couples to identify The birth control patch is a type of contraception the day closest to ovulation and narrow the that contains the hormones estrogen and EL estimated fertile window. progestin. You wear the patch to avoid becoming pregnant. Hormonal Methods The transdermal contraceptive patch is a safe and Oral contraceptives convenient birth control method that works really GU Commonly known as the pill well if you always use it correctly. OC4 (for oral contraceptive) COC4 (for combination oral contraceptives) Intramuscular Injections Contain synthetic estrogen and progesterone suppressing Depo-Provera MI ovulation (single injection every 12 weeks) inhibits ovulation estrogen- acts to suppress follicle stimulating hormone -advantage: long term reliability/ (FSH) and LH (Luteinizing Hormone) to suppress ovulation -disadvantage: weight gain, headache , depression , Progesterone – causes & decrease in the permeability of irregular menses, loss of bone mineral density. cervical mucus and so limits sperm motility and access to L. ova. Intrauterine Devices Interferes with tubal transport and endometrial A small T-shaped device that is inserted into the uterus proliferation to an extent the possibility of implantation is through the vagina N decreased. May contain copper or progesterone YA Benefits of oral Contraceptives: Barrier Methods Decreasing the incidence of: Barrier method are forms of birth control that place a Dysmenorrhea because of lack of ovulation chemical or latex barrier between the cervix and advancing Premenstrual dysphoric syndrome and acne sperm so sperm cannot reach and fertilize an ovum. BR because of the increased progesterone levels SPERMICIDES Iron deficiency anemia because of the reduced -An agent that causes the death of spermatozoa before they amount of menstrual flow can enter the cervix. Acute pelvic inflammatory disease (PID) and -often combination of other physical barrier methods resulting tubal scarring ICK Endometrial and ovarian cancer, ovarian cysts, and ectopic pregnancies Fibrocystic breast disease TR PROGESTIN-ONLY PILLS (MINI PILLS) - Containing only progestin's - Without estrogen content, ovulation may occur, but because the progestins have not allowed the PA endometrium to develop fully or sperm to freely access the cervix, fertilization and implantation will not take place. Subcutaneous Implants Consist of 6 non-biodegradable implants filled with synthetic progesterone Diaphragm Embedded just under the skin on the inside A circular rubber disk that is placed over the cervix of the upper arm where it will slowly release before intercourse progestin over a period of 3 years Use of a spermicidal gel with a diaphragm Barely noticeable, appears as an irregular combines a barrier and a chemical method of crease on the skin, like a small vein contraception Cervical Cap The hysterectomy and bilateral salpingo-oophorectomy will A soft rubber that fits snugly over the uterine cervix both be done during one procedure. This surgery will Use with a spermicidal gel remove the uterus, cervix, ovaries, and fallopian tubes. After a hysterectomy you will no longer have periods or be able to become pregnant EL Male Condom GU Latex rubber or synthetic sheath that is placed over the Vasectomy erect penis before coitus begins Male sterilization Female Condom The vas deferens are cut and occluded, blocking the Latex sheaths made of polyurethrane and pre-lubricated passage of spermatozoa MI with spermicide Surgical Methods Tubal Ligation WEEK 10 Female sterilization Fallopian tubes are occluded, preventing IMMEDIATECAREOFTHENEWBORN: L. passage of both sperm and ova The period from birth to 28 days of life is called neonatal period and infant in this is termed as neonate or newborn baby. N The first week of life is known as early neonatal period and the late neonatal period extends from YA 7th day to 28 days of age. Care given to newborn during neonatal period is known as new born care. BR TYPES OF NEWBORN CARE: 1.Immediate care of newborn–care of the baby that needs to be given at birth in the labor room 2.Later care of newborn –care of the baby that needs to be given in the postnatal ward and after discharge at home. ICK HYSTERECTOMY Immediate Care of Newborn -Removal of uterus or ovaries Objectives FIMBIECTOMY 1.Establishment of respirations and maintenance of a TR -Removal of fimbria at the distal end of the tubes patent airway. SALPINGECTOMY >Suction the newborn starting from the mouth and then -removal of the entire fallopian tube and fimbria nose. Laparoscopy technique- surgical procedure where small Do not start in nose since it can cause aspiration PA incision is made in the abdomen for the purpose of viewing Suction gently and quickly or performing surgery on the organs of the pelvis or Prolonged and deep suctioning of the naso pharynx during abdomen. the first 5-10 minutes after birth will stimulate the vagus nerve (located in the esophagus) and cause bradycardia TAH-BSO What is a total abdominal hysterectomy with a bilateral 2. Position the baby in a Trendelenburg position inside the salpingo-oophorectomy? crib, except when there are signs of increased intracranial Hysterectomy is a surgery to remove the uterus and cervix. pressure: “Abdominal” is the surgical technique that will be used. > shrill, high pitched cry This means the surgery will be done through an incision in > Vomiting your abdomen. A bilateral salpingo-oophorectomy is > Tensed, bulging anterior fontanel surgery to remove both of your ovaries and fallopian tubes. * Quickly examine the infant for respiratory problems and abnormality The intent of this scoring system is to help identify newborns at risks of complications 3.Maintain appropriate body temperature ØA score is given for each sign at one minute and five If temperature is below 35 degrees C, hypothermia occur minutes after birth Baby will chill and uses a lot of glucose leading to ØIf there are problems with the newborn, an additional hypoglycemia score is given at 10 minutes Baby will also use the fats that leads to the release of fatty ØA score of 7-10 is considered normal acids leading to respiratory acidosis Ø4-7-require some resuscitative measures Remember: ØA score of 3 and below-requires immediate resuscitation The moment the baby is out, dry him The majority of heat loss occurs because of four separate Birth weight mechanism: A baby's birth weight is an important marker of health. EL 1. convection-air conditioner Full-term babies are born between 37 and 41 weeks of 2. radiation-cold window/aircon pregnancy. The average weight for full-term babies is about 3. conduction-warmed blanket 7 pounds (3.2 kg). In general, very small babies and very 4. evaporation-warm blanket/skin to skin contact large babies are at greater risk for problems. Babies are GU weighed every day in the nursery to look at growth, and the 4.Perform APGAR Scoring baby’s need for fluids and nutrition. Newborn babies may Apgar scoring often lose 5% to 7% of their birth weight. This means that a The Apgar score helps find breathing problems and other baby weighing 7 pounds 3 ounces at birth might lose as MI health issues. It is part of the special attention given to a much as 8 ounces in the first few days. Babies will usually baby in the first few minutes after birth. The baby is gain this weight back within the first 2 weeks after birth. checked at 1 minute and 5 minutes after birth for heart and Premature and sick babies may not begin to gain weight respiratory rates, muscle tone, reflexes, and color. A baby right away. who needs help with any of these issues is getting constant Most hospitals use the metric system for weighing babies. L. attention during those first 5 to 10 minutes. In this case, the This chart will help you convert grams to pounds. actual Apgar score is given after the immediate issues have been taken care of. Converting grams to pounds and ounces: N 1 lb. = 453.59237 grams; 1 oz. = 28.349523 grams; 1000 Each area can have a score of 0, 1, or 2, with 10 points as grams = 1 Kg. YA the maximum. Most babies score 8 or 9, with 1 or 2 points taken off for blue hands and feet because of immature Measurements circulation. If a baby has a difficult time during delivery and The hospital staff takes other measurements of each baby. needs extra help after birth, this will be shown in a lower These include: BR Apgar score. Apgar scores of 6 or less usually mean a baby Head circumference. The distance around the baby's head. needed immediate attention and care. Abdominal circumference. The distance around the belly (abdomen). SIGNS 0 1 POINT 2 Length. The measurement from top of head to the heel. The staff also checks these vital signs: ICK POINT POINTS Temperature. This checks that the baby is able to have a A Appearance: Pale all Pink pink all stable body temperature in normal room. Skin Color over, body, over Pulse. A newborn’s pulse is normally 120 to 160 beats per blue-gr blue minute. TR ay extremiti Breathing rate. A newborn’s breathing rate is normally 40 es to 60 breaths per minute. P Pulse Rate Absent Below Above Physical exam PA 100bpm 100bpm A complete physical exam is an important part of newborn care. The healthcare provider carefully checks each body G Grimace No With Sneezes, system for health and normal function. The provider also Respon slight coughs, looks for any signs of illness or birth defects. Physical exam se grimace pulls of a newborn often includes: away General appearance. This looks at physical activity, muscle A Activity:Mus Absent, Arms and Active tone, posture, and level of consciousness. cle Tone Limp/ legs moveme Skin. This looks at skin color, texture, nails, and any rashes. flaccid flexed nt Head and neck. This looks at the shape of head, the soft spots (fontanelles) on the baby’s skull, and the bones across R Respiration Absent weak/ Good cry the upper chest (clavicles). irregular Face. This looks at the eyes, ears, nose, and cheeks. Mouth. This looks at the roof of the mouth (palate), tongue, and throat. Lungs. This looks at the sounds the baby makes when he or she breathes. This also looks at the breathing pattern. Heart sounds and pulses in the groin (femoral) Abdomen. This looks for any masses or hernias. Genitals and anus. This checks that the baby has open passages for urine and stool. Arms and legs. This checks the baby’s movement and development. Gestational assessment The healthcare provider will check how mature the baby is. EL This is an important part of care. This check helps figure out the best care for the baby if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than he or she appears by size, and may need GU different care than a premature baby needs. Healthcare providers often use an exam called the Dubowitz/Ballard Examination for Gestational Age. This exam can closely estimate a baby's gestational age. MI The exam looks at a baby's skin and other physical features, plus the baby’s movement and reflexes. The physical maturity part of the exam is done in the first 2 hours of birth. The movement and reflexes part of the exam is done within L. 24 hours after birth. The provider often uses the information from this exam to help with other maturity estimates. N Maturity of nerves and muscles Physical maturity The healthcare provider does 6 checks of the baby's nerves YA The physical maturity part of the Dubowitz/Ballard exam and muscles. looks at physical features that look different at different A score is given to each area looked at. Typically, the more stages of a baby's gestational age. Babies who are physically mature the baby is, the higher the score. These are the mature usually have higher scores than premature babies. areas checked: BR Points are given for each area of assessment. A low of -1 or Posture. This looks at how the baby holds his or her arms -2 means that the baby is very immature. A score of 4 or 5 and legs. means that the baby is very mature (postmature). These are “Square window.” This looks at how far the baby's hands the areas looked at: can be flexed toward the wrist. Arm recoil. This looks at how much the baby's arms "spring ICK Skin textures. Is the skin sticky, smooth, or peeling? back" to a flexed position. Soft, downy hair on the baby’s body (lanugo). This hair is Popliteal angle. This looks at how far the baby's knees not found on immature babies. It shows up on a mature extend. infant, but goes away for a postmature infant. “Scarf sign.” This looks at how far the baby’s elbows can be TR Plantar creases. These are creases on the soles of the feet. moved across the baby's chest. They can be absent or range up to covering the entire foot. Heel to ear. This looks at how near the baby's feet can be Breast. The provider looks at the thickness and size of moved to the ears. breast tissue and the darker ring around each nipple PA (areola). Eyes and ears. The provider checks to see if the eyes are fused or open. He or she also checks the amount of cartilage and stiffness of the ears. Genitals, male. The provider checks for the testes and how the scrotum looks. It may be smooth or wrinkled. Genitals, female. The provider checks the size of the clitoris and the labia and how they look. When the physical assessment score and the nerves and medical term for the newborn infant's first stools. muscles score are added together, the healthcare provider Meconium is composed of amniotic fluid, mucus, lanugo can estimate the baby’s gestational age. Scores range from (the fine hair that covers the baby's body before birth), bile, very low for immature babies to very high scores for mature and cells that have been shed from the skin and intestinal and postmature babies. tract. In some cases, the baby passes stools (meconium) All of these exams are important ways to learn about your while still inside the uterus. baby's well-being at birth. By finding any problems, your baby's doctor can plan the best possible care. URINARY SYSTEM The developing baby's kidneys begin producing urine by 9 Physiologic Function Changes in the newborn at birth to 12 weeks into the pregnancy. After birth, the newborn LUNGS, HEART, AND BLOOD VESSELS will usually urinate within the first 24 hours of life. The The mother's placenta helps the baby "breathe" while it is kidneys become able to maintain the body's fluid and growing in the womb. Oxygen and carbon dioxide flow electrolyte balance. EL through the blood in the placenta. Most of it goes to the The rate at which blood filters through the kidneys heart and flows through the baby's body. This allows for the (glomerular filtration rate) increases sharply after birth and baby to have the proper amount of these chemicals in their in the first 2 weeks of life. Still, it takes some time for the body. kidneys to get up to speed. Newborns have less ability to GU At birth, the baby's lungs are filled with fluid. They are not remove excess salt (sodium) or to concentrate or dilute the inflated. The baby takes the first breath within about 10 urine compared to adults. This ability improves over time. seconds after delivery. This breath sounds like a gasp, as the newborn's central nervous system reacts to the sudden IMMUNE SYSTEM MI change in temperature and environment. The immune system begins to develop in the baby, and continues to mature through the child's first few years of Once the baby takes the first breath, a number of changes life. The womb is a relatively sterile environment. But as occur in the infant's lungs and circulatory system: soon as the baby is born, they are exposed to a variety of Increased oxygen in the lungs causes a decrease in blood bacteria and other potentially disease-causing substances. L. flow resistance to the lungs. Although newborn infants are more vulnerable to infection, Blood flow resistance of the baby's blood vessels also their immune system can respond to infectious organisms. increases. Newborns do carry some antibodies from their mother, N Fluid drains or is absorbed from the respiratory system. which provide protection against infection. Breastfeeding The lungs inflate and begin working on their own, moving also helps improve a newborn's immunity by continuing to YA oxygen into the baby's bloodstream and removing carbon supply antibodies from the mother to the baby. dioxide by breathing out (exhalation). BODY TEMPERATURE SKIN A developing baby produces about twice as much heat as Newborn skin will vary depending on the length of the BR an adult. A small amount of heat is removed through the pregnancy. Premature infants have thin, transparent skin. developing baby's skin, the amniotic fluid, and the uterine The skin of a full-term infant is thicker. wall. Characteristics of newborn skin: After delivery, the newborn begins to lose heat. Receptors A fine hair called lanugo might cover the newborn's skin, on the baby's skin send messages to the brain that the especially in preterm babies. The hair should disappear ICK baby's body is cold. The baby's body creates heat by within the first few weeks of the baby's life. burning stores of brown fat, a type of fat found only in A thick, waxy substance called vernix may cover the skin. fetuses and newborns. Newborns are rarely seen to shiver. This substance protects the baby while floating in amniotic fluid in the womb. Vernix should wash off during the baby's TR LIVER first bath. In the baby, the liver acts as a storage site for sugar (in the The skin might be cracking, peeling, or blotchy, but this form of a chemical called glycogen) and iron. When the should improve over time. baby is born, the liver has various functions: PA It produces substances that help the blood to clot. Neuromuscular System It begins breaking down waste products such as excess red -term newborns demonstrate neuromuscular function by blood cells. moving their extremities, attempting to control head It produces a protein that helps break down bilirubin. If the movements, exhibiting a strong cry, and demonstrating baby's body does not properly break down bilirubin, it can newborn reflexes. lead to newborn jaundice. The blink reflex -a blink reflex in a newborn serves the same purpose as it GASTROINTESTINAL TRACT does in an adult-to protect the eye from any objects A baby's gastrointestinal system doesn't fully function until coming near it by rapid eyelid closure. after birth. It may be elicited by shinning a strong light such as a In late pregnancy, the baby produces a tarry green or black flashlight into an eye. waste substance called meconium. Meconium is the  -the lateral surfaces of the foot bend as if to make a cup out of the plantar surface The rooting reflex -disappears at 8 to 9 months -The rooting reflex in babies is a basic survival instinct. This reflex helps your baby find and latch onto a bottle or your The tonic neck reflex breast to begin feeding. When you gently stroke the corner -Tonic neck reflex or "fencing“or boxer posture of your baby's mouth with your nipple, they should You may notice that when your baby's head turns to one instinctively turn their head toward it to nurse. side, his corresponding arm will straighten, with the opposite arm bent, as if he's fencing. The sucking reflex -disappears on the 2nd and 3rd months of life. -When the roof of the baby's mouth is touched, the baby will start to suck. This reflex doesn't start until about the The moro reflex 32nd week of pregnancy and is not fully developed until -The Moro reflex is a normal reflex for an infant when he or EL about 36 weeks. Premature babies may have a weak or she is startled or feels like they are falling. immature sucking ability because of this. The infant will have a startled look and the arms will fling -newborns lips are touched, the baby makes a sucking out sideways with the palms up and the thumbs flexed. motion. Absence of the Moro reflex in newborn infants is abnormal GU -begin to diminish at about 6 months of age. and may indicate an injury or disease. -strong for the 1st 8 weeks of life and then fades by the end The swallowing reflex of the 4th or 5th month. -It is integrated by 12-18 months. Swallowing Reflex: The MI swallow is initiated when food, liquid, or saliva reaches your The Babinski reflex baby's throat. Your baby comes under control of this reflex -When the sole of the foot is firmly stroked, the big toe by 18 months and it continues as an important reflex bends back toward the top of the foot and the other toes throughout our lives. fan out. -Swallowing reflex serves as a defensive airway reflex. Any This is a normal reflex up to about 2 years of age. L. procedures that disturb the coordination of respiration and swallowing may increase the chance of pulmonary aspiration. N The extrusion reflex YA -When your baby pushes solid food out of their mouth using their tongue, it's called the extrusion reflex (it's also referred to as tongue-thrust reflex). While it may seem discouraging that your baby doesn't want to try new BR textures, this reflex is a primitive instinct to protect them. -fades at 4months The palmar grasp reflex -The palmar grasp reflex is present at birth and persists until ICK 4 to 6 months of age. When an object is placed in the The magnet reflex infant's hand, the fingers close and tightly grasp the object. -if pressure applied to the sole of the feet of a newborn The grip is strong but unpredictable. lying in a supine position, they push back against the --fades about 6 weeks to 3 months of age; after it fades, a pressure. TR baby begins to grasp meaningfully. -this and the two following reflexes are test of spinal cord integrity. The step(walk)-in-place reflex -newborns who are held in a vertical position with their feet The crossed extension reflex PA touching a hard surface will take a few quick, alternating -if the sole of baby's foot is stimulated and the lower limb is steps. held in extension, baby should extend his other leg and -disappears by 3 months of age. bring it closer to the stimulated one as if to ward off "the tickle". The placing reflex -elicited by touching the anterior lower leg against a surface The trunk incurvation reflex such as the edge of a table. -Truncal incurvation or Galant reflex The newborns makes few quick lifting leg motions, as if to The Galant reflex is tested by holding the baby face-down in step onto the table. one hand while using the other hand to stroke the baby's skin along either side of the spine. The plantar grasp reflex -The baby's spine should curve in response, causing the head and feet to move towards the side being stroked.  Newborns will have their hearing screened while still in the hospital. The landau reflex Smell -The Landau is an important postural reflex and should Studies have found that newborns have a strong sense of develop by 4 to 5 months of age. smell. Newborns prefer the smell of their own mother, -When the infant is suspended by the examiner's hand in especially her breastmilk. the prone position, the head will extend above the plane of Taste the trunk. Babies prefer sweet tastes over sour or bitter tastes. Babies -The trunk is straight and the legs are extended so the baby also show a strong preference for human milk and is opposing gravity. breastfeeding. This is especially true if they are breastfed first and then offered formula or a bottle. The deep tendon reflex Touch EL -The first thing is to use a reflex hammer, not a finger or a Babies are comforted by touch. Placing a hand on your stethoscope. Ideally, the baby is in a quiet alert state with baby's belly or cuddling close can help him or her feel more the head in the midline. secure. Wrapping your baby snugly in a blanket (swaddling) -The head turned to one side can reinforce the tone and is another technique used to help newborn babies feel GU reflexes on that side. I usually start with the knee jerk secure. You can buy a special swaddling blanket designed to because is the easiest to obtain. make swaddling easier. -Take control of the leg with the hand under the knee and the leg at about a 90 degree angle at the knee. Nutritional Allowances for newborn MI -Then strike the patellar tendon with the reflex hammer For newborns using a pendular action rather a chopping action. Breast milk is ideal for newborns up until 6 months (and can - Reposition the leg and try several times if you have be continued up until the mother and their child have trouble getting a knee jerk. mutually understood that breastfeeding can stop). - Absence of deep tendon reflexes is a much more However, babies older than 6 months can still breastfeed L. important finding than hyperreflexia in the along with eating solid food. newborn. A normal newborn can have Breastfeeding should start immediately after birth hyperreflexia and still be normal, if the tone is Breast milk provides all of the nutrients that a growing baby N normal, but absent reflexes associated with low needs. tone and weakness is consistent with a lower For mothers who are not able to breastfeed, formula milk YA motor neuron disorder. can be an alternative. However, exclusive breastfeeding is still recommended by doctors. Please consult your The senses of a newborn doctor/pediatrician first before starting formula milk Babies are born with all 5 senses—sight, hearing, smell, It is important to note that not all formula milk is created BR taste, and touch. Some of the senses are not fully equal. When choosing the right formula milk for your baby, developed. The newborn's senses are as described below. always consult your doctor. Sight COLOSTRUM- a thin watery, yellow fluid composed of Over the first few months, babies may have uncoordinated protein, sugar, fat, water, minerals, vitamins, and maternal eye movements. They may even appear cross-eyed. Babies antibodies. ICK are born with the ability to focus only at close range. This is about 8 to 10 inches, or the distance between a mother's Solid food face to the baby in her arms. Babies are able to follow or Soft/Solid food is not a replacement for track an object in the first few weeks of life. Focus improves Breastfeeding/Breast milk… it is only a “complement” for TR over the first 2 to 3 years of life to a normal 20/20 vision. breastmilk. Newborns can detect light and dark but can't see all colors. Introduce soft, solid foods slowly. Wait 3-4 days before This is why many baby books and infant toys have distinct giving your child another solid food. black and white patterns. Use a small spoon when feeding your baby, and feed them PA only small amounts to avoid choking. Hearing Don’t force your baby to finish their food, especially if they During pregnancy, many mothers find that the baby may are already full. kick or jump in response to loud noises and may quiet with At 6 to 8 months old, start with soft, mushy foods that are soft, soothing music. Hearing is fully developed in easily digestible. newborns. Babies with n