By the end of the infant and maternal care lectures, you should be able to:
Discuss the Personal Support Worker (PSW) role in maximizing aids and minimizing barriers to development for clients and families.
Describe changes and needs experienced by the family during the postpartum period.
Distinguish between expected changes and signs/symptoms requiring assessment and/or intervention.
Differentiate between postpartum blues, depression, and psychosis.
Discuss personal care procedures for both the mother and infant during the postpartum period.
Overview of Birth Parents and Infants
Birth parents and newborns usually have short hospital stays, whether the birth occurs in a hospital or at home.
Common reasons for requiring home care after discharge include:
The birth parent experienced complications before or after childbirth.
The birth parent needs assistance with other young children at home.
There was a multiple birth.
The birth parent lives with a physical or mental health disability.
The newborn has special needs.
The birth parent has difficulty adjusting to new parental responsibilities.
Caring for New Birth Parents
Postpartum Definition: The period after childbirth.
The postpartum period starts at the birth of the baby and lasts for six weeks.
Adjustments include:
Physical changes experienced by the birth parent and emotional adaptation to childbirth.
In caring for the parent, a support worker will:
Provide physical and emotional care for the birth parent.
Provide care for the newborn.
Assist with childcare for other children in the home.
Help with home management tasks.
Physical Changes in Postpartum Period
The postpartum period encompasses physical, hormonal, and emotional changes from birth to six weeks after delivery.
Lochia (Vaginal Discharge):
Expulsion of blood and other substances (including mucus and uterine tissue) from the uterus.
Changes in color and decreases over time, typically heavy for the first 10 days.
Amount increases with activity and breastfeeding. Rest can reduce the amount and change color.
Uterine Changes Post-Birth
The uterus contracts to shrink to its normal size and position, with contractions felt as mild labor pains occurring during breastfeeding, triggered by the hormone oxytocin released during feeding.
Lochia Types
Lochia Rubra: Dark or bright red discharge seen during the first 3 to 5 days, mainly composed of blood.
Lochia Serosa: Pinkish-brown drainage lasting until about 10 days post-birth.
Lochia Alba: Whitish drainage continuing for 2 to 6 weeks after birth.
Normal lochia smells like menstrual flow; foul-smelling lochia signals potential infection.
Postpartum Complications Related to Lochia
Signs of complications include:
Foul-smelling discharge.
Large volume of discharge.
Pad soaked within one hour.
Presence of large blood clots.
Perineal Care in the Postpartum Period
Importance of Good Perineal Care:
Change sanitary pads frequently.
Use a squirt bottle for perineal cleaning.
Wipe from front to back after elimination.
Essential hand washing after perineal care, changing pads, and eliminating.
Episiotomy Care
Episiotomy: An incision made into the perineum to enlarge the vaginal opening during childbirth.
Can be performed to prevent tearing of the perineum; the area may be swollen, sore, and tender post-operation.
Sitz baths may be ordered for comfort and hygiene, and complications like infection and wound separation (dehiscence) can develop.
Types of Perineal Care
Includes analgesics, sitz baths, cold packs, and regular warm baths for comfort and healing.
Cold Pack Application
Cold packs cause blood vessel constriction, reducing pain and preventing swelling.
Applied and removed in 15-minute increments.
Signs of Complications with Cold Pack Use
Watch for:
Shivering.
Skin irritation.
Complaints of pain, numbness, or burning.
Skin discoloration (cyanotic, pale, white, or grey).
Check every 5 minutes for symptoms of complications.
Sitz Bath Benefits
Immersion in warm or hot water provides:
Pain relief.
Promotion of healing.
Stimulation of voiding and increased circulation.
Cleaning of perineal wounds.
Duration typically lasts 15 minutes, with monitoring for risk of dizziness and fainting.
Caesarean Section Care
Some birth parents may deliver via cesarean section, requiring care for the abdominal incision at the site.
Reasons for C-section include:
Medical emergencies necessitating immediate delivery.
Baby's size or position making vaginal delivery risky.
Maternal health concerns (e.g., infections).
It is crucial to avoid lifting, housework, and monitor for signs of infection, such as:
Pain, bleeding, redness, swelling, and drainage.
Breast Care and Lactation
Lactation: The process of producing and secreting milk, typically starting around the third day post-birth.
Breast engorgement can occur, characterized by swollen, hard, and painful breasts.
Colostrum: Clear, antibiotic-rich fluid secreted for the first 2–3 days before milk production begins.
Engorgement can lead to latching difficulties if not managed properly.
Plugged Milk Ducts
Causes a tender lump in the breast when milk is not drained properly.
Can lead to mastitis (breast infection) if untreated.
Treatment highlights:
Frequent breastfeeding, especially from the affected breast.
Avoid tight clothing that may compress the duct.
Apply warm washcloths to the affected area.
Managing Engorgement
Effective management includes:
Manual pumping to promote an effective latch.
Continued breastfeeding.
Warm showers, use of a supportive bra, and cold packs.
Mastitis
Characterized as an infection of the breast that occurs when bacteria enter a milk duct through a cracked nipple.
Symptoms of mastitis include:
Painful inflammation with soreness and tenderness.
Symptoms may escalate to feverish feelings and being achy.
Treatment must be prompt, usually with antibiotics, and breastfeeding is encouraged to maintain milk flow through ducts.
Emotional Changes Post-Childbirth
Common emotional reactions following childbirth stem from multiple factors:
Lack of sleep, increased responsibilities, new parental roles, feelings of isolation, disappointment, anxiety, poor body image, lack of support, and hormonal fluctuations.
Postpartum Blues
Also known as "baby blues," these feelings of sadness occur within the first two weeks postpartum.
Up to 80% of women experience this temporary emotional distress due to hormonal changes and stress in their new roles.
Symptoms may include rapid mood swings from happiness to sadness.
Postpartum Depression
Major depression can occur any time within the first year postpartum, characterized by:
Feelings of sadness, worthlessness, hopelessness, guilt, and anxiety.
Loss of interest in formerly enjoyable activities.
Social withdrawal, difficulty in focusing, and changes in sleeping/eating patterns.
Signs of Postpartum Depression
Symptoms may include:
Crying episodes, feelings of despair or guilt.
Difficulty sleeping, inability to cope with daily problems, avoidance of social situations.
Anger directed at the baby, fatigue, extreme anxiety.
Possible thoughts of self-harm or harm to the baby, including delusions or hallucinations.
Postpartum Psychosis
A severe form of postpartum depression with symptoms including:
Delusions, hallucinations, suicidal thoughts, and potential harm or neglect toward the child.
Infant Care
Infant safety and security is paramount, requiring proper hand hygiene and adherence to care plans to meet evolving physical and emotional needs.
Illness in Infants
Infants can become ill quickly; watch for signs such as:
Low body temperature (less than 36.1°C) or high temperature (greater than 37.5°C).
Rapid breathing (over 60 breaths per minute), poor feeding, vomiting, or sudden changes in stool patterns.
Severe signs include a sunken fontanelle, difficulty breathing, cyanotic skin, and sudden behavioral changes.
Notify a supervisor immediately upon noticing any concerning symptoms.
Handling and Care of Infants
Infants must be handled gently, ensuring support for their entire body and head.
Avoid sudden movements or jerking actions that can upset them.
Swaddling should be done with care to prevent overheating, and parents' routines should be respected.
Diapering Practices
Diaper changes should occur promptly when wet or soiled to prevent diaper rash. Cloth diaper care includes rinsing, using hot water for washing, and thorough drying.
Disposable diapers should be securely fastened with Velcro, and soiled diapers should be disposed of hygienically.
Care of the Umbilical Cord
The umbilical cord connects the parent and fetus, and care must be taken to keep the stump clean and dry until it falls off (typically 7-10 days post-birth).
Signs of infection around the stump may include redness, odor, and drainage; report these to a healthcare provider.
Circumcision Care
Post-circumcision care includes keeping the area clean, loose diaper application, and monitoring for symptoms of infection.
Bathing Infants
Bathing is crucial for hygiene, skin care, and nurturing. Sponge baths should be given until the baby is about 2 weeks old, followed by tub baths once healed.
Infant Feeding Reflexes
Rooting reflex: Infants turn toward touch on their cheek/mouth.
Sucking reflex: Stimulated by touch to lips, enabling milk extraction from the breast.
Assisting with Breastfeeding and Formula Preparation
Provide a calm environment for breastfeeding, ensuring hygiene and fluid replacement.
Formula preparation must not include cow’s milk, and sterilization of water and equipment is vital for infants under 4 months old. Options include ready-to-feed, concentrated, or powdered formula.