Nina Ian John “G” Rachel Mark Ivz Jobe Jocelle Edo Gienah Jho Kath Aynz Je Glad

Nickie Rico Teacher Dang Niňa Arlene Vivs Paul F. Rico F. Ren Mai Revs Mavis Jepay Yana Mayi Serge Hung Tope Ag Bien

S2 Lec 3(2 of 2): Breastfeeding, Home Delivery, Newborn by Dra. Teresita Cadiz-Brion AAuugguusstt 2233,, 22001100

o Mother and baby are not separated for 30mins-1hr (baby should be
ASSESSMENT OF THE NEWBORN colonized by the bacteria of the mother)
o After first full feed, baby is bathed, immunizations are given and the rest
Neonatal period of the newborn care are routinely done
-1st 4 wks of life (28 days)
- Infant mortality rate APGAR SCORING SYSTEM
- 1985: 45/1000 live births -reflective for need of resuscitation
- 1990: 24.3/1000 live births Appearance
-neonatal deaths – 48% of total infant deaths & majority took place in the Pulse
1st week of life Grimace
Activity
Leading Causes of Infant Mortality Respiration
1. Respiratory conditions of the fetus and newborn
2. Congenital anomalies Sign 0 1 2
3. Birth injury Heart rate Absent <100 >100
4. Difficult labor (pulse)
Respiratory Absent Slow, irregular Good, regular,
General Management of the Newborn effort crying
o The outcome of the neonatal depends on his/her ability to adapt to Muscle tone Flaccid Some flexion of Active recoil
extrauterine environment extremities
o He will need to take over the function of breathing, maintaining Reflex irritability No response Grimace Vigorous
circulation, nutrition & excretion. (grimace)
o The newborn needs immediate assistance at birth, primarily for Color Blue, pale Body pink, Completely pink
establishment of respiration, maintenance of body temperature, provision (appearance) extremities blue
for adequate nutrition & prevention of infection.  Done during the 1st minute and at 5 minutes
 If score at 5 minutes is <7, additional score every 5 minutes is
Management After Delivery taken until the 20th minute unless 2 successive scores 8
1. wipe face
2. suction nares & oral cavity during restitution  APGAR score is not indicative of the newborn’s ability to survive
3. dry baby Interpretation:
4. rub body stimulation 7-10 = good
5. tap soles 4-6 = mild to moderate asphyxia
6. get APGAR sore 0-3 = severe asphyxia

o Immediately after birth, the neonate’s head is held downward in order Lack of Effective Respiration (causes)
to clear the mouth, nose & pharynx of fluid, mucus, blood & amniotic 1. Fetal hypoxemia or acidosis from any cause
debris. 2. Drugs given to mother
o The upper airway may be cleared w/ a rubber bulb syringe or a 3. fetal immaturity
catheter. 4. upper airway obstruction
o Once meconium is detected in the amniotic fluid, the larynx should be 5. pneumothorax
visualized & any meconium removed promptly 6. lung abnormalities – hypoplasia
o If infant is depressed, tracheal intubation & suctioning should be done 7. MAS
to clear any aspirated material from beneath the glottis 8. CNS abnormality
o If the baby is vigorous & spontaneously breathing, the indication for 9. Septicemia
aggressive removal is less clear.
Principles of Resuscitation
ESSENTIAL NEWBORN CARE ABC
o After delivery, cord is not clamped at once o open Airway
o May wipe the face but the nares are not suctioned o initiate Breatihng
o Put baby face down on body of the mother (skin to skin contact) o assure Circulation
o When there are no more pulsations, clamp then cut the cord (to avoid
fetal anemia)
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3 Signs to be Evaluated D. Vitamin K
o respiratory effort o Prevent hemorrhagic disease of the newborn
o heart rate -Vitamin K-dependent factors: II, VII, IX, X
o color -Vitamin K (phytonadione)
o 1mg IM term
LATCHING ON o 0.5mg for preterm
o the stable newborn is wiped dry & placed on the mother’s chest for
immediate bonding (w/in 30 mins – 1 hr after birth) E. Cord care
o the mother is encouraged to initiate breastfeeding during this time
o Suckling: oxytocin release, uterine contractions, less bleeding o strict aseptic precautions
o apply povidone-iodine daily
TEMPERATURE REGULATION o separation in 3-45 days; faster if exposed to air
To minimize heat loss o neonatal tetanus
o Dry skin
o Provide adequate dry covering for the baby including the head F. Observe passage of urine & meconium shortly after birth
o Avoid exposure to air conditional vents & electric fans as well as contact w/ o indicates patency of the GIT & urinary tracts
cold surfaces
o Droplight (25-30 W) over the basinet UNIVERSAL NEWBORN SCREENING
Routine newborn screening for 5 conditions (1996)
Maintain temp: 36.4 – 37.2o C 1. congenital hypothyroidism
2. congenital adrenal hyperplasia
Failure to maintain temperature range can lead to cold stress: 3. phenylketonuria
o Peripheral vasoconstriction 4. galactosemia
o Hypoxia 5. G6PD deficiency
o Anaerobic metabolism Hearing Screening
o Acidosis (treatment: bicarbonate, intubation, naloxone if due to anesthetic
depression) ROOMING-IN
o Death o Trend to make childbearing as natural as possible
o Foster mother-child relationship
ROUTINE NEWBORN CARE o Mother’s increased ability to assume full care of the baby when she arrives
home
A. Estimation of Gestational Age
1. sole creases PLACE OF DELIVERY
2. breast nodules o majority of deliveries take place at home (next common are gov’t
3. scalp hair hospitals then private hospitals)
4. ear lobes o attendants at birth (in descending order) midwife, hilot, physician
5. testes & scrotum
CONCLUSIONS
B. Care of the Eyes o 7/10 of women deliver at home
o Gonococcal/ Chlamydia conjunctivitis/Ophthalmia neonatorum o Strengthen the support system
o Silver nitrate (Crede’s prophylaxis) – may cause chemical conjunctivitis ; o Virtually all births were delivered w/ some assistance
no longer used o Prenatal care was most often given by a nurse or midwife
o Give penicillin, tetracycline, erythromycin
o Other causes of Neonatal Conjunctivitis
Staphylococcus aureus HOME DELIVERY
Streptococcus pneumoniae
Neisseria meningitides -Commonly practiced
Pseudomonas aeruginosa -Danger of being managed by untrained personnel
Haemophilus influenzae -Inability of caretaker to identify high risk pregnancies needing more care
Escherichia coli -Resources for transfer may be inadequate or unavailable
Herpes virus

C. Permanent Infant Identification Role of the Midwives & Primary care

o Identification band 1. Rendering services in the supervision and care of women during
o Footprints (not preferred) pregnancy, labor and puerperium
2. Management of normal deliveries including IE during labor
3. Health education of patient, family and community

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 4. Primary health care services in the community including nutrition and o vital signs and FHT
family planning o prevention of infection
5. Giving immunizations o reduction of anxiety
6. Oral or parenteral dispensing of oxytocic drug after delivery of the o empty bladder
placenta
7. Suturing perineal lacerations to control bleeding Second Stage of Labor
8. Giving IVF during obstetric emergencies o Cleanse vulva with betadine cleanser and antiseptic
9. Injecting Vit. K to the newborn o Scrub hands and wear sterile gloves
o Patient prepared – semi Fowler, dorsal lithotomy position
When Do You Refer? High Risk Pregnancies o Set up sterile equipment
 Maternal Conditions o Advice mother to bear down
1. Abnormal OB history
a. CPD Third Stage of Labor
b. Pre-eclampsia o Observe for signs of placental separation
c. Antepartum h’ge  uterus becomes round and globular
d. Polyhydramnios  lengthening of the cord
e. Previous CS  sudden gush of blood
f. Forceps delivery  the uterus rises up in the abdomen
g. Post-partum h’ge o Placenta delivered
h. Adherent placenta  Modified Crede’s Maneuver- separated placenta pushed
i. Elderly primigravida downward on the fundus
2. Abnormal medical history  Brandt-Andrews Maneuver- put pressure on suprapubic
a. Cardiac disease area
b. TB o Examine placenta
c. DM o Check birth canal for lacerations
d. serious anemia o Oxytocics – methylergometrine
e. venereal disease o Mother’s vital signs

 Fetal Conditions PUERPERAL CARE

1. History of repeated stillbirths O Encourage to move around
2. Neonatal death or no living child O Balanced diet
3. Malpresentation O Pain control as needed
4. <34 weeks AOG O Daily routine check-up
5. Rh incompatibility  TPR, BP,fundus, lochia, perineum
6. Fetal monstrosities  Breast and perineal care
o Encourage breastfeeding
Home Delivery (again) o Teach family care of mother and baby
A. Advantages of Home Delivery
 Emotional support by husband/family
 Less danger of nosocomial infections Home Delivery(Yet Again)
 Less expensive o REGISTER!
 Responsibility of the MD, nurse, midwife and parent
B. Conditions not favorable to home delivery  Ensure that the certificate is accurately and completely
 Presence of infectious diseases filled up
 Overcrowding
 Destitution or poverty BREASTFEEDING
 Unsanitary conditions
In Utero
 Secretory buds
C. Disadvantages of Home Delivery
 Inner layer- secretory epithelium
 Lack of services
 Outer layer- myoepithelium (mechanism for milk ejection)
 Lack of sophisticated equipment
 Lack of trained personnel Endocrinology of Lactation
 Progesterone withdrawal during delivery removes inhibitory effect on
GENERAL PRINCIPLES IN THE MANAGEMENT OF LABOR production of α- lactalbumin
First Stage of Labor  Allows prolactin to act unopposed in production of α- lactalbumin
o careful observation of the progress of labor (Partograph or the  Increased α- lactalbumin stimulate lactose synthase activity
Friedman’s curve)  Each act of suckling triggers rise in prolactin and oxytocin levels

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 Posterior pituitary secretes oxytocin  contraction of myoepithelial
cells causing milk ejection

Characteristics of Human Milk

 600 ml/day Brought to you by: OBwan-Kenobi
 Isotonic w/ plasma
(RPE-JCF-PF-SAH)
 Proteins: α- lactalbumin, β-lactoglobulin, casein
 Epidermal growth factor
 Lactose “With OBwan-Kenobi, everyone can OB” :D
 All vitamins except K
 Breastfed infants are aware of what their mother’s eat and drink

Colostrum
 Deep, lemon-yellow colored liquid, usually expressed from the nipples
by the 2nd day (or in the first few postpartum days)
 Contains more minerals, protein but less sugar and fat ANY ANNOUNCEMENT YOU WANT THE CLASS
 Contains antibodies, macrophages, lymphocytes, lactoferrin,
lactoperoxidase, and lysozymes TO KNOW?
 Each act of suckling triggers rise in prolactin and oxytocin levels
 Posterior pituitary secretes oxytocin
ANY EVENT YOU WANT TO PROMOTE?
 Contraction of myopepithelial cells causing milk ejection

Colostrum
Contains more minerals and
proteins (globulin)
Less sugar and fat
Persists for 5 days
Antibodies (IgA)- protection
against enteric pathogens
* give vit. K to newborns as prophylaxis to prevent hemorrhagic disease of
the newborn
Mature Human Milk
Suspension of fat and protein
PLACE YOUR AD
in a carbohydrate solution
Major proteins are α-
lactalbumin, β-lactoglobulin,
and casein
HERE! :D
All vitamins are present except Contact: 09064352344
*Vit. K NOTE: This is not a joke! Contact the number above if you have any
announcements or events instore for us. Thank you.:D

Contraindications
 Diseases
 CMV
 Hepatitis B
 HIV
 TB?
 Drugs
o Amphetamines
o Cocaine
o Heroin
o Marijuana
o Nicotine
o Phencyclidine
o Psychotropic drugs
o Antianxiety drugs
o Antidepressants
o Antipsychotics
o Chloramphenicol
o Metoclopramide
o Metronizadole
o Tinidazole

Health workers have the responsibility of encouraging mothers to

breastfeed their babie

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