Lesson 3: Postpartum Postpartal
Period
 Also known as Puerperium (from
Latin word puer,"child" and
parere, "to bring forth”
 Time from birth until the
woman’s body returns to an
essentially pre-pregnant condition

 Refers to the 6-week period after
childbirth. A time of maternal
changes thatare retrogressive
(involution of the uterus &
vagina) & progressive
 (production of milk for lactation,
restoration of the normal
menstrual cycle, & a beginning
of a parenting role)
 herself-with watchful guidance
 Popularly termed as the fourth
semester of pregnancy.
Psychological Changes of the
Postpartal Period
Behavioral Adjustment:
Phases of The Puerperium (TiThL)
- Taking-in
- Taking-hold
- Letting go
Taking-In Phase
 The first phase experienced
 A time of reflection for the
woman.
 Woman usually wants to talk
about her pregnancy, especially about
her labor & birth
 The woman is largely passive.
 The dependence is due partly to
her physical discomfort from
 possible perineal stitches, after
pains or hemorrhoids; partly to
her uncertainty in caring for a
newborn; & partly from extreme
exhaustion that follows childbirth
 She holds the child with a sense
of wonder
 She needs time to rest & regain
her physical strength & to calm &
contain
Taking-Hold Phase
 A woman begins to initiate
action
 Now she takes a strong interest
to take care of her child and
begins maternal role behaviors.
 It is best to give woman brief
demonstration of baby care &
allow her to care for the child
She often feels insecure about her
ability to care for her new child
 She needs praise for the things
she does well to give her
confidence
 For many young mothers,
learning to make decisions about
their child's welfare is one of the
most difficult phases of
motherhood.
Letting-Go Phase
 The woman finally redefines her
role.
 There is an adaptation of
parenthood and definition of new
role as a parent.
 She gives up the fantasized
image of her child & accepts the
real one
 She gives up her old role of
being childless or the mother of
only one or two
 A woman who has reached this
phase is well inclined into her
new role
Development of Parental Attachment,
Bonding, and Positive Family
Relationships
Attachment or Bonding
 Term used to describe a woman that
has successfully linked with her
newborn.
 Skin-to-skin contact soon after
birth encourages the early
attachment and binding phase.
This should ideally occur within
the first hour of any birth, even
cesarean deliveries, as soon as the
mother and baby are stable and
last until completion of the first
breastfeeding
 When the mother is looking
directly at her newborn’s face,
with direct eye contact (termed
an en face position), is a sign a
mother is beginning effective
attachment.
Rooming-In
  Occurs when the baby stays
with her mother in the room.
 In order for a hospital to qualify
as “baby friendly,” a hospital
must provide “rooming-in,” or
space to keep the infant with the
parents.
Sibling Visitation
 Sibling chance to visit the
hospital can reduce feelings that
their mother cares more about the
new baby than about them and
also help to make
the baby a part of the family.
Maternal Concerns and Feelings in the
Postpartal Period
Abandonment
 Mother admits feeling
abandoned and less important
after birth.
 Only hours before, the woman
was the center of attention, now
suddenly the baby is the chief
interest.
Disappointment
  It can be difficult for parents to
feel positive immediately about a
child who does not meet their
expectations.
  The nurse in the short time
may change a mother's or father's
feelings. It is possible for the
nurse to at least help a person
involved to take a clearer look at
parent’s situation and begin to
cope with the new circumstances.
Postpartal Blues
  Transient disorder that occurs
within 2-3 days after delivery,
peaking on the 5th day and
usually resolves within 10-14
days.
  As many as 50% of woman
experience some feelings of
overwhelming sadness for which
they cannot account.
  Characterized by mild mood
swings that begin to develop after
the patient arrives home from the
hospital and tends to be worse in
primis.
  They burst into tears easily or
may feel let down or be irritable.
  May be due to hormonal
changes particularly the decrease
of estrogen and progesterone that
occurs with the delivery of
placenta.
  The syndrome is evidenced by
tearfulness, feelings of
inadequacy, mood lability,
anorexia and sleep disturbance.
 Signs & Symptoms:
o Feeling tired & overwhelmed,
irritable
o Overly sensitive
o Anxiety
o Poor concentration & insomnia
 Management:
o It is self-limiting and has little effect
on the woman's ability to
carry out her normal daily function.
o Medication is not required
o Provide supportive care & education
is important:
o Inform woman that her feelings are
normal
o Encourage woman to discuss her
feelings
o Recommend to seek assistance in
baby care and other household chores
until she has adjusted well to her new
role & responsibilities to ease the
feelings of being overwhelmed &
avoid excessive fatigue.
Postpartal Depression
If a mother appears to have a level of
depression that is beyond baby blues
and/or has a history of previous
postpartal depression (PPD), closer
observation and referral is indicated
immediately.
Physiologic Changes of the Postpartal
Period
A. Reproductive System Changes
The Uterus
  Involution is the process
whereby the reproductive organs
return to their non-pregnant state.
The woman is in danger of
hemorrhage from the uterus until
involution is complete.
2 Processes involve in Involution:
First: Area of placental implantation
was sealed off to prevent
Bleeding The sealing of the placenta
site is accomplished by rapid
contraction of the uterus immediately
after delivery of the placenta.
This contraction pinches the blood
vessels. As time goes by, thrombi
form within the uterine sinuses and
permanently seal the area.
Eventually, endometrial tissue
undermines the site and obliterates the
organized thrombi, covering and
healing the area so completely the
process leaves no scar tissue within the
uterus so does not
compromise future implantation sites.
Second: Uterus is reduced to its
approximate pregestational size.
The same contraction process reduces
the size of the uterus.
Devoid of the placenta and the
membranes, the walls of the uterus
thicken and contract, gradually
reducing the size of the uterus. A
phenomenon that can be compared
with a rubber band that has been
stretched for many months and now is
regaining its normal contour.
None of the rubber band is destroyed;
the shape is simply altered.
Weight of the Uterus...
Immediately after birth: 1000 grams
End of 1st week: 500 grams
After 6 weeks (by the time involution
is complete): 50 grams
  Immediately after delivery, the
uterus becomes a hard, immobile
structure located just above the
pubic bone. And it is slightly
tender when palpated
Breast Feeding promotes uterine
Involution...
The uterus of a breastfeeding mother
may contract even more quickly
because oxytocin, which is released
with breastfeeding, stimulates uterine
contractions.
The Fundus
  Should be checked after the
bladder is emptied because a full
bladder displaces the uterus
upwards and to the sides. The
fundus is normally located in the
midline of the abdomen.
  A well-contracted fundus feels
so firm. If on palpation the
 uterus feels boggy (soft or
flabby):
o Massage it gently in circular motion
o Place the infant on the mother's
breast to stimulate uterine
contractions by the release of oxytocin.
o Administer oxytocin.
Height of the fundus...
Immediately after delivery: located
midway between the umbilicus &
symphisis pubis or slightly higher.
After 1 hour: it rises to the level of the
umbilicus, where it remains
approximately the next 24 hours.
***Then, descends into the pelvic
cavity by 1 cm or 1
fingerbreadth a day.
9th - 10th day: The uterus is withdrawn
it the pelvis and can
no longer be detected by abdominal
palpation.
Uterine contractions and afterpains
  Strong uterine contractions
may cause uncomfortable
intermittent cramps called
afterpains similar feeling during
menstruation.
Common among the following:
o Multiparas
o Women treated with oxytocin
o Breastfeeding mothers
o Women whose uterus is
overcdistended.
Unusual to primipara because they still
have good uterine muscle tone.
  Afterpains are present for 2-3
days.
The Lochia
 2 Distinct Layers of the Decidua by
the 2nd day after birth:
The inner layer attached to the
muscular wall of the uterus serve
as the foundation from which a new
layer of endometrium will be
formed.
The layer adjacent to the uterine cavity
becomes necrotic and is cast
off as a vaginal discharge similar to a
menstrual flow. This flow,
consisting of blood, fragments of
decidua, white blood cells, mucus,
and some bacteria, is termed lochia
The Lochia...
On the first 3 days after birth, a lochia
discharge consists almost entirely of
blood, with only small particles
of decidua and mucus, because of its
red color, it is called lochia rubra.
About the 4th day, as the amount of
blood involved decreases and
leukocytes begin to invade the area, as
they do with any healing surface, the
flow becomes pink or brownish (lochia
serosa).
On about the 10th day, the amount of
the flow decreases and becomes
colorless or white with streaks of
brownish mucus (lochia alba). Lochia
alba is present in most women until the
third week after birth, although it is
not unusual for a lochia flow to last the
entire 6 weeks of the puerperium.
  It takes approximately 6 weeks
(the entire postpartal period) for
the placental implantation site to
be healed.
  Lochia is ever absent
regardless of the method of
delivery.
  Less lochia is expected to the
following:
o Women who delivered via CS.
o Women who ambulates early
o Women who breastfeed their babies
The Cervix
  The cervix contracts less
slowly than the uterus.
o Immediately after delivery it
becomes an opening of about 2-3
cm in diameter with flabby, irregular
edges. Also the cervix feels
soft and malleable to palpation
o But at the end of 7 days, the cervical
opening becomes much
narrower and can admit just the tip of a
finger. The cervix feels
firm and nongravid again.
The Vagina
  After the delivery, the vagina
is a loose canal stained with
blood.
  It has flabby walls without
much of the irregularity normally
present.
  But it heals quite rapidly and
by the end of the week almost
looks like its pre-pregnant state.
The Perineum
  Immediately after birth,
perineum is edematous and
tender because of great amount of
pressure experienced during
birth.
  Ecchymosis may show on the
surface because of ruptured
capillaries.
  The labia majora and labia
minora typically remain atrophic
and softened after birth, never
returning to their prepregnancy
state.
Check the perineum for the following:
REEDA
o Redness
o Edema
o Ecchymosis
o Discharge/ drainage
o Approximation
The Breast
 Drop in estrogen and progesterone
initiate lactation/milk production
 Breastfeeding
o Milk supply will "come in" in 48 to
72 hours after delivery.
o Your breasts will become firm and
tender. If you are
breastfeeding, frequent nursing will
help prevent engorgement.
o If you are not breastfeeding, you can
advise the mother to express
the milk and store in the refrigerator.
o Apply ice packs to decrease the
swelling.
o Consider a mild pain reliever, such
as Tylenol. Avoid warm water
directly on your breasts when you
shower.
o If you do not wish to become
pregnant again right away, you must
use some type of birth control.
o Breastfeeding will not prevent you
from becoming pregnant again.
Breast feeding & Return of Menstrual
Cycle...
Non-breastfeeding women, ovulation
returns 4 weeks after delivery and
menstruation returns after 6 - 10 weeks
Breastfeeding women, menstruation
returns about 3 - 4 months after
childbirth, or in some for the entire
lactation period.
B. Systemic Changes
The Hormonal System
  Pregnancy hormones begin to
decrease as soon as the placenta
is no longer present.
  After 24 hours, levels of
human chorionic gonadotropin
(hCG) and human placental
lactogen (hPL) are almost
negligible.
 By week 1, progestin, estrogen,
and estradiol are all at
prepregnancy levels (estriol may
take an additional week before it
reaches prepregnancy levels).
  For about 12 days, follicle-
stimulating hormone (FSH)
remains low and then begins to
rise as a new menstrual cycle is
initiated.
The Urinary System
  The bladder wall becomes
edematous and swollen
  The muscles of the urethra
become loose and flabby due to
stretching during the delivery.
  Pressure by the fetal head also
tends to decrease the vitality of
the bladder and the urethra.
o As a result, there may be some
difficulty in passing urine for the
first 24 hours after the delivery.
o But the muscle tone is regained in 1 -
2 days.
 During pregnancy, 2000 mL to 3000
ml excess fluids accumulates in
the body, so extensive diaphoresis
(excessive sweating) and diuresis
(excess urine production) takes place
almost immediately after
birth thus increasing the daily output to
rid the body of this excess
fluids. The daily urine output of a
postpartal woman from a normal level
of 1,500 ml to as much as 3,000
ml/day during the second to fifth day
after birth.
The Circulatory System
 The blood loss at birth and diuresis
that is evident between the second
and fifth days after birth reduce the
added blood volume a woman
accumulated during pregnancy. The
blood volume returns to its normal
prepregnancy level by the first or
second week after birth.
 Blood Loss during vaginal delivery
and caesarian delivery:
o Vaginal delivery: 300ml - 500 ml
o Caesarian delivery: 500ml - 1000 ml
Blood loss & diuresis
contribute to reduction in blood
volume 40% increase in blood
volume during pregnancy enters the
maternal circulation within 5-
10 minutes after placental delivery.
 The level of plasma fibrinogen
remains high during the first postpartal
weeks as they did during pregnancy,
this serve as a protective measure
against hemorrhage.
  The white blood cell count
may be as high as 30,000
cells/mm3
compared to a normal level of 5,000 to
10,000 cells/mm3, a defense
against infection and an aid to healing.
  Bilateral ankle edema is not
uncommon but should not
progress above the knees. The
ankle edema decreases over time
as fluid shifts and returns to the
circulatory system.
The Gastrointestinal System
  Women may feel hungry after
delivery because of the food &
fluid restriction.
  There may be increased thirst
during the first few days after
delivery since there is increased
fluid loss.
  Bowel movement may be
delayed for days after delivery,
because of the still-present effect
of relaxin.
  Constipation can occur as a
result of dehydration.
  Pain from the episiotomy
wound, vaginal and perineal area
can also contribute to
constipation.
The Integumentary System
  Striae gravidarum still appear
reddened and may be even more
prominent than during pregnancy. In
White woman, these will fade to a pale
white over the next 3 to 6 months
whereas in a Black woman, they may
remain as areas of slightly darker
pigment.
 Chloasma and on Linea nigra
will become barely detectable by
6
weeks’ time.
  Diastasis recti, will appear as a
slightly indented bluish streak in
the abdominal midline
Retrogressive Changes of the
Puerperium
Exhaustion
 After labor and delivery, a woman
experiences total exhaustion, she may
feel
“sleep hunger”.
Weight Loss
 A weight loss of about 4kg takes
place at the time of delivery of the
baby, placenta, membranes and liquor
amnion.
 A further loss of about 3Kg takes
place during the puerperium due to the
elimination of water and decreased
size of the uterus
Progressive Changes of the
Puerperium
The period of puerperium involves
progressive changes, or the building of
new tissue.
Lactation
Lactogenesis means human milk
production
4 Phases of Lactogenesis
Lactogenesis I (milk synthesis) process
begins around 16 weeks gestation as
the
glandular luminal cells in the breast
begin secreting colostrum, a thin,
watery
prelactation secretion.
Lactogenesis II is triggered at birth by
the delivery of the placenta, when the
progesterone hormone and other
circulating pregnancy hormones
suddenly
decrease and oxytocin sharply
increases as a result of the infant
suckling.
In Lactogenesis II mothers feel that
their “milk has come in”
(engorgement) and
occurs from birth to 5 to 10 days
postpartum; this is often termed
“transitional
milk.”
Lactogenesis III can occur from day 10
until weaning postpartum, when the
“mature milk” supply is now driven by
the circulating lactation hormones
oxytocin and progesterone.
Lactogenesis IV occurs after complete
weaning and the breasts involute to
their
prelactation state.
Prolactin hormone is responsible for
milk production
Oxytocin is responsible for the let-
down reflex arch.
Lactation or the formation of breast
milk begins in a postpartal mother
whether she
plans to breastfeed or not.
 Early in pregnancy, there is an
increased level of estrogen produced
by the
placenta. It stimulated the growth of
milk glands and breasts increased in
size
because of these larger milk glands,
accumulated fluid, and some extra
adipose tissue.
 Breast milk forms in response to the
decrease level of estrogen and
progesterone that follows delivery of
the placenta and an increase in
prolactin and oxytocin.
 For the first 2 days after birth, the
mother may notice little change in her
breasts from the way they were during
pregnancy because, since midway
through pregnancy, she has been
secreting colostrum.
 On the third or fourth day after
birth, the mother may feel tension in
the breast
termed primary engorgement. It fades
as the infant begins effective latching
and begins transferring colostrum
initially followed by milk from the
breasts.
Return of Menstrual Flow
The production of placental estrogen
and progesterone ends because of the
delivery of placenta. The resulting
decrease in estrogen and progesterone
concentrations causes a rise in
production of FSH by the pituitary,
which leads, with
only a slight delay, to the return of
ovulation. This initiates the return of
normal
menstrual cycles.
Vital Sign Changes
Pulse Rate
 The pulse rate normally rises during
the labor. It continues to be variable in
the first two days after delivery.
 Then comes back to normal on the
third day.
 Orthostatic Hypotension during 1st
48 hours after delivery is expected
Temperature:
 The temperature often becomes
slight increase during the first 24 hours
after
birth because of dehydration that
occurred during labor. It comes back
to
normal if she takes in adequate fluid
during the first 24 hours.
 On the third day, there may be a
slight rise in temperature because of
the
letting down reflex of milk with a
consequent mild engorgement of the
breasts.
 Any woman whose oral temperature
rises above 100.4°F (38°C), excluding
the first 24-hour period, to be febrile,
and such a high temperature may
indicate a postpartal infection.
Blood Pressure:
 Carefully monitor blood pressure
during postpartal period:
o A decrease in blood pressure can
indicate bleeding
o An elevation above 140 mmHg
systolic or 90 mmHg diastolic may
indicate the development of postpartal
hypertension
Nursing Care of a Woman and Family
in Preparation for Health Agency
Discharge
Pospartal Discharge Health Teachings:
  Menstruation and Ovulation
o Non-lactating: ovulation returns 4
weeks after delivery and menstruation
returns after 6 - 10 weeks
o Lactating: menstruation returns
about 3 - 4 months after childbirth, or
in some for the entire lactation period.
  Ambulation
o NSD - allowed ambulating 4-8 hours
after birth.
o CS - allowed to get out of bed after 8
hours when already fully awake &
reflexes have returned.
  Rest and Sleep
o Woman should rest & sleep as much
as needed during the early
postpartum period to overcome
fatigue, excitement, anxiety &
discomfort.
o May resume light housekeeping on
the 2nd week and can go back to
normal activities by 4-6 weeks
o For CS - advised to go back to
normal activities by 12-16 weeks.
  Resumption of Sexual Activity
o Can be resumed 3-4 weeks after
vaginal & CS delivery if bleeding has
stopped, perineum is healed and if not
cause pain to the woman
  Clinic Visit/ OPD
o Follow-up check-up both for the
mother and baby is 1 week after
Discharge
Care of Newborn
1. Airway
 Maintain respiration at 30-50 bpm
without retraction and grunting.
 Suction secretion gently by a bulb
syringe.
To establish respiration:
1. Wipe mouthy and nose after
delivery
2. Suction secretion gently by a bulb
syringe:
M (mouth): 5cm first, then N (nose):
3cm before
the first breath to prevent aspiration.
 Stimulate crying only after
secretions are removed to prevent
aspiration
How to stimulate crying? Try this...
Rub the soles of feet.
 Vigorous suctioning using catheters
causes vasovagal response. It will
result to bradycardia.
Suction for the following situation:
1. Possible resuscitation
2. Newborn does not cry
3. Meconium staining
2. Warm
 Rub dry; swaddle and loose blanket;
place in warm or unwrapped in
radiant heat warmer.
 Take axillary temperature at the end
of 1st hour of life, then every 4 hours
for the 1st 24 hours of life, once a day,
onwards, (to prevent bowel
perforation); If rectal, the purpose is to
detect imperforate anus.
3. Monitor Character of Crying
 Vigorous crying blows off extra
carbon dioxide
 Note for the time of gasping and
crying after birth
Crying...
Increase depth of respiration, aerating
deep portion of the
lungs.
4. Umbilical Cord
 Assess umbilical cord pulsation
 Note the number of vessels of the
cord- 2 arteries, 1 vein- immediately
after cutting
 Assess cord for possible bleeding
 Avoid using creams, lotions or oils
near the cord to hasten drying and
prevent infections.
5. Eye Care
 Crede prophylaxis - gonorrheal
conjunction prophylaxis
 Erythromycin ointment or drops
may be used.
 Use individual tube or package per
infant. Instill or squeeze ointment
along the lower eyelid from the inner
canthus outward.
6. Initial Feeding
 May breastfeed immediately after
birth
 The Philippine Milk Code EO 51
promotes
breastfeeding
 Breastfeeding and Rooming- in Act
of 1992 RA
7600 also promotes breastfeeding and
requires
immediate rooming in of the newborn
7. Bathing
 Complete sponge bath is done 6
hours after birth when newborn
temperature and vital signs are stable.
 Once a day, thereafter limiting to
face, diaper area and skin folds only
 Room temperature should be 24C
(75F) to prevent chilling
 Bath water should be 98F to 100F
(37C to 38C), a temperature that is
warm to the elbow or wrist.
 Use mild neutral soap.
 Bathe prior to, not after, a feeding to
prevent spitting, vomiting or
aspiration.
 Proceed from cleanest to dirtiest
area of the body. Start on the eyes and
face to the trunk and extremities, last-
diaper area.
 Wash eyes using clean water from
inner cantus outward using separate
clean portion of washcloth for each
eye, to prevent spread of infection to
the other eye
 Don’t soak the cord, because a wet
cord is a good breeding ground of
bacteria.
 No tub bath until cord has fallen off
 Wash skin creases as milk tends to
collect in these areas during spitting
 Don’t retract forcefully the foreskin
of uncircumcised penis to prevent
constriction of the penis
 Wash female vulva, wipe from front
to back, to prevent contamination of
the vagina or urethra by rectal bacteria.
8. Vitamin K Administration
 0.5 to 1.0 mg of Vitamin K
(Phytomenadione or
AquaMEPHYTON),
immediately after birth to prevent
hemorrhagic disease
 Administered IM at vastus lateralis
(anterolateral thigh muscle)
Newborn’ GI is sterile at birth...
Vitamin K is synthesized through the
action of intestinal
flora. Newborns’ gastrointestinal tract
is sterile at birth.
Therefore, they are at risk for bleeding
disorders during
the first week because newborn are
unable to produce
vitamin K, a vitamin necessary for
blood coagulation.
9. Identification
 Name tag or identification band is
attached to a newborn
 Foot stamping
Infant identification is important...
It is important because a newborn may
be handed or
given to the wrong mother or be
switched or abducted.
The Physiologic Adjustment to
Extrauterine Life
Period of reactivity
It is a phase of instability during the
first 6 hours of life
through which all newborns pass
regardless of AOG,
nature of labor and delivery.
Demonstration of these
typical reactivity patterns shows that
the newborn’s
neurologic system is intact and healthy
and the newborn is
adjusting well to extrauterine life.
Periods of Reactivity:
1. First Period (First 15-30 minutes)
 Newborn exhibits
o Rapid respiration, transient nostril
flaring, retraction and grunting
o Heart rate may reach up to 180 bpm
during the first few hours of
life
2. Resting Period (30-120 minutes)
 Newborn is quiet, relax and falls
asleep
3. Second Period (2-6 hours)
 Starts when the newborn awakes
 Newborn exhibits
o Hyper- responsiveness to stimuli
o Rapid heart rate
o Change of color from pink to slightly
cyanotic.
Apgar Scoring
 Assessment scale used as a standard
for newborn evaluation.
 Done at 1 minute and 5 minutes
after birth.
 The 5 parameters include
appearance, pulse, grimace, activity
and respiration
 Scoring is 0, 1 and 2
 Highest possible score is 10
APGAR Scoring
 Appearance
 Pulse
 Grimace
 Activity
 Respiration
Assessment of Gestational Age
 Term newborns are those born
between 37 and 42 weeks of gestation.
 Specific findings from physical
assessment provide clues to a
newborn’s
gestational age.
 As early as 1966, Usher and
colleagues propose 5 criteria to
evaluate
gestational maturity.
Criteria for Gestational Assessment
(BESST)
 Breast nodule diameter
 Ear lobe
 Sole creases
 Scalp hair
 Testes and scrotum
Weight: 2,500- 3,400 grams or 2.5-3.5
kilograms
 Mature female newborn is 3.4
kilograms (7.5 pounds)
 Mature male newborn is 3.5
kilograms (7.7 pounds)
 Macrosomic- term newborn who
weighs more than 4.7 kilograms
Length: 46-54 centimeters
Head Circumference: 33-35
centimeters (13.5 to 14 inches.).
Chest Circumference: 30.5-33
centimeters
Temperature: Axillary: 36.5C- 37F
(97.9F-98F)
Temperature will fall...
The temperature of newborns is about
99°F (37.2°C) at
birth and will fall almost immediately
to below normal
because of heat loss, the birthing
rooms’ temperature and
the infant’s immature temperature
regulating
mechanisms.
Heat loss mechanism
 Convection
o Flow of heat from the newborn’s
body surface to cooler
surrounding air.
o Prevent heat loss from convection:
Eliminate drafts from air
conditioners.
 Radiation
o Transfer of body heat to a cooler
solid object not in contact with
the baby.
o Prevent heat loss from radiation:
Move the infant as far from the
cold surface.
 Conduction
o Transfer of body heat to a cooler
solid object in contact with a
baby.
o Prevent heat loss from conduction:
Cover the surfaces with a
warmed blanket or towel.
 Evaporation
o Loss of heat through conversion of a
liquid to a vapor.
o Newborns are wet when born, so
they can lose a great deal of
heat as the amniotic fluid on their skin
evaporates.
o Prevent heat loss from evaporation:
 Lay the newborn on the mother’s
abdomen immediately
after birth and cover with a warm
blanket for skin-to-skin
contact
 Dry the infant, especially the face
and hair. The head is
considered a large surface area in a
newborn, it can be
responsible for a great amount of heat
loss.
 Cover the hair with a cap after
drying.
Infant’s immature temperature
regulating mechanisms
 Insulation, is not as effective in
newborns because they have little
subcutaneous fat. It is an efficient
means of conserving heat in adults
 Shivering, increases metabolism and
thereby providing heat in adults,
is also rarely seen in newborns.
Newborns can conserve heat by:
 Constricting blood vessels and
moving blood away from the skin.
 Brown fat, are found in the
intrascapular region, the thorax, and
behind
the kidneys. It is a special tissue found
in mature newborns, it helps to
conserve or produce body heat by
increasing metabolism as well as
regulating body temperature.
 Kicking and crying, increases the
newborn’s metabolic rate and
produce more heat.
Newborn’s temperature stabilizes...
The newborn’s temperature stabilizes
at 98.6°F
(37°C) within 4 hours after birth. With
an infection, a
newborn may run a subnormal
temperature. So if a
newborn’s temperature does not
stabilize shortly after
birth, the cause needs to be
investigated to rule out an
infection
Pulse: Apical:120-140 bpm
Respiration: 30-60 bpm
Count the Respiratory Rate...
Count the respiratory rate by watching
the movement of a
newborn’s abdomen because breathing
primarily involves
the use of the diaphragm and
abdominal muscles.
Obligate nose breathers...
Newborns are obligate nose breathers
and they show
signs of distress if their nostrils are
obstructed.
Blood Pressure:
 At birth, about 80/46 mmHg
 On the 10th day, about 100/50
mmHg and remains at that level for the
infant
year.
Newborn BP is not routinely
measured...
It is not routinely measured because
measurement is
somewhat inaccurate due to the small
size of their arms
unless a cardiac anomaly is suspected.
For more accurate
reading, the cuff width used must be
no more than 2/3 the
length of the upper arm or thigh.
Common Variations of Vital Signs:
 Crying increases body temperature,
increases blood pressure, heart and
respiratory rate
 Radiant warmer will falsely increase
axillary temperature
 Sleep decreases respiratory and
heart rate
 During the 1st period of reactivity
(6-8 hours), respiratory rate can reach
80bpm and heart rate can reach 180
bpm
Physiologic Functions: Changes in All
Major Body Systems
Cardiovascular System
Before, placenta is responsible for
oxygenating blood. As
soon as the umbilical cord is clamped,
the newborn is
stimulated to take in oxygen through
the lungs. And fetal
cardiovascular shunts begin to close.
 With the 1st breath, blood pressure
decreases in the pulmonary artery. As
the
blood pressure decreases, the ductus
arteriosus begins to close.
 At the same time, there is an
increased blood flow to the left side of
the heart
which causes the foramen ovale to
close. But permanent closure does not
occur for weeks.
 The umbilical vein, two umbilical
arteries, and ductus venosus no longer
receive blood from the placenta, the
blood within them clots and closes
them,
and the vessels atrophy over the next
few weeks.
Acrocyanosis...
The peripheral circulation of a
newborn remains sluggish
for at least the first 24 hours, which
can cause acrocyanosis and for the feet
to feel cold to the touch
The Respiratory System
 Fluid in the lungs make a newborn’s
first breath possible because the fluid
eases surface tension on alveolar walls
and allows alveoli to inflate more
easily than if the lung walls were dry.
Baby born through Vaginal Birth...
Because of the pressure of vaginal
birth, about 1/3 of the
fluid is forced out of the lungs. After
the 1st breath, the rest
of the fluid is quickly absorbed by
lung blood vessels and
lymphatics. Once the alveoli have been
inflated, breathing
becomes much easier for a newborn.
Baby born by cesarean birth...
A baby born by cesarean birth has
more difficulty
establishing respiration because
excessive fluid blocks air
exchange space. Most of the lungs
fluid is not expelled at
birth.
Lack of pulmonary surfactant ...
Preterm newborn has a lack of
pulmonary surfactant.
Because of this their alveoli may
collapse each time they exhale. As a
result, they also have difficulty
establishing effective residual capacity
and respirations.
The Gastrointestinal System
 A newborn stomach capacity: about
60 to 90 ml
 For the first few months of life,
pancreatic enzymes, lipase and
amylase, remain deficient. As a result,
a newborn has limited ability to digest
fat and starch.
 The newborn tends to regurgitate
easily because their cardiac sphincter
between the stomach and esophagus is
still immature.
 Immature liver function can lead
lowered glucose and protein serum
levels.

The Urinary System
 Newborn voids within 24 hours
after birth.
 The kidneys of newborns do not
concentrate urine well, making
newborn urine
usually light colored and odorless. By
6 weeks of age concentration of urine
becomes evident.
 A single voiding in a newborn is
only about 15 ml, with specific gravity
ranges
from 1.008 to 1.010.
 The 1st voiding may be pink or
dusky because of uric acid crystals that
were
formed in the bladder in utero
 Newborn’s daily urinary output for
the first 1 or 2 days is about 30 to 60
ml
total.
 By week 1, total daily urine output
rises to about 300 ml.
 Diapers can be weighed to
determine the amount of voiding.
The Immune System
 Newborns are not able to produce
antibodies until about 2 months.
Because
of this they have limited immunologic
protection at birth.
 But they are born with passive
antibodies (immunoglobulin G) passed
to them
from their mother that crossed the
placenta. In most instances, these
include
antibodies against:
o Poliomyelitis
o Measles
o Diphtheria
o Pertussis
o Chickenpox
o Rubella
o Tetanus.
The Neuromuscular System
Reflex
 Term newborn demonstrates
neuromuscular function by moving
their
extremities, attempting to control head
movement, and demonstrating
newborn reflexes.
Eyes
Blinking or Corneal Reflex
 Infant blinks with sudden
appearance of bright light or approach
of an object
towards the cornea
 Purpose: To protect the eye from
any object coming near.
 Persists throughout life
Pupillary Reflex
 Pupils constrict (bright light shines
toward it)
 Persist throughout life
Doll’s Eye Reflex
 As the head is moved slowly (right
or left), the eyes lag behind and do not
immediately adjust to the new position
of the head
 Disappears as fixation develops
Nose
Sneeze Reflex
 Spontaneous response of nasal
passages to irritation or obstruction
 Persist throughout life
Glabellar Reflex
 Tapping briskly on the bridge of the
nose (glabella)
 Eyes close tightly
Mouth and Throat
Sucking Reflex
 When newborn’s lip are touched,
the baby makes a sucking motion
 Purpose: Serves to help a newborn
find food.
 Diminished at 6 months of age
Gag Reflex
 Stimulation of posterior pharynx
causes the infant to gag
 Persist throughout life
Rooting Reflex
 Touching or stroking the cheek
along the side of the infant’s mouth
causes the
head to turn towards that side and the
infants begins to suck
 Purpose: Serves to help a newborn
find food.
 Should disappear at about 6 weeks
of life
Swallowing Reflex
 Food that reaches the posterior of
the tongue is automatically swallowed.
Extrusion Reflex
 When tongue is touched or
depressed, infant responds by forcing
it outward
 Purpose: Prevent the swallowing of
inedible substances.
 Disappears by age 4 months.
Yawn Reflex
 Spontaneous response to decreased
oxygenation by increasing the amount
of
inspired air
 Persist throughout life
Cough Reflex
 Irritation of the mucus membrane of
the larynx or tracheobronchial tree
causes coughing
 Persist throughout life, usually
present after the first day of birth
Extremities
Grasp Reflex
 Touching palms of hands or sole of
feet (near base of digits) causes flexion
(hands and toes)
 Palmar grasp: disappears at about 6
weeks to 3 months of age (replaced by
voluntary movement)
 Plantar grasp: disappears at about 8
to 9 months of age in preparation for
walking
Babinski Reflex
 Stroking outer sole of foot in an
inverted “J” curve from the heel
upward, a
newborn fans the toes (positive
Babinski sign)
 Remains positive until 3 months of
age.
General
Moro (startle) Reflex
 Elicited by sudden loud noise or
hold the newborn in a supine position
and
then allow the head to drop backward
about 1 inch.
 In response to this, the newborn will
extend the arms and legs, then swings
the arms into an embrace position and
pulls up the legs against the abdomen.
 Strong for the first 8 weeks of life
 Fades by the end of the fourth or
fifth month.
Magnet Reflex
 Apply pressure to the soles of the
feet of the newborn lying in supine
position,
the newborn will push back against the
pressure.
 Purpose: Tests of spinal cord
integrity.
Tonic Neck Reflex
 Also called “Boxer” or “Fencing
Reflex”
 When infants head is turned to one
side; the arm and the leg extend on that
side, and the opposite arm and leg flex
 Disappears by age 2 to 3 months.
Crossed Extension Reflex
 When a newborn is lying in supine
position, if one leg is extended and the
sole
of that foot is irritated by being rubbed
with a sharp object, the infant raises
the other leg and extends it as if trying
to push away the hand irritating the
first
leg
 Purpose: Tests of spinal cord
integrity.
Trunk Incurvation Reflex
 Stroking the infants back along the
side of spine causes the hips to move
toward stimulated ide
 Disappears by 4 weeks
 Purpose: Tests of spinal cord
integrity.
Step (Walk)-in-Place Reflex
 The infant is held so that sole of
foot touches a hard surface and then
there is
reciprocal flexion and extension of the
leg that stimulates walking
 Disappears by 3 months of age;
replaced by deliberate movement
Placing Reflex
 Infant is held upright under the arms
while the dorsal side of foot is briskly
placed against a hard object, the
resulting effect is that the leg lifts as if
the
foot were stepping on a table.
Landau Reflex
 When the newborn is supported in a
prone position by a hand, the newborn
should demonstrate some muscle tone.
Senses are fully developed at birth
Hearing
 By 25 to 27 weeks’ gestation,
hearing is functional and the fetus can
hear the
mother’s heartbeat and voice.
Vision
 By 26 weeks’ gestation, the fetus
has a blink or squint reflex in response
to a
bright light in utero.
 At birth, pupillary reflex or ability
to contract the pupil is present.
 Newborns demonstrate they can see
by blinking at a strong light.
 Newborn cannot follow an object
past the midline
 Newborns focus best on black and
white objects at a distance of 9 to 12
inches.
Touch
 At birth, sense of touch is well
developed.
Taste
 Taste buds are developed and
functioning even before birth.
 Newborn has the ability to
discriminate taste.
Smell
 The sense of smell is present in
newborns as soon as the nose is clear
of
lung and amniotic fluid.
The Physical Examination
The Skin
Color
 For the first month, term newborns
have a ruddier complexion because of
the
increased concentration of red blood
cells in their blood vessels and a
decrease in the amount of
subcutaneous fat, which makes blood
vessels
more visible.
Cyanosis
 Acrocyanosis
o Because of m immature peripheral
circulation, the lips, hands, and feet
are likely to appear blue
o Normal finding at birth through the
first 24 to 48 hours after birth.
 Central cyanosis
o Cyanosis of the trunk
o Always a cause for concern
o Indicates decreased oxygenation
probably because of:
 Temporary respiratory obstruction
 Respiratory or cardiac disease.
Hyperbilirubinemia
 Caused by the accumulation of
excess bilirubin in blood serum.
 Physiologic jaundice
o On the 2nd or 3rd day, the
newborn’s skin and sclera of the eyes
begin
to appear noticeably yellow.
o Heme and globin are released, as a
result of a breakdown of fetal red
blood cells.
o Common therapy: Phototherapy-
exposure of the infant to light to
initiate maturation of liver enzymes.
Pallor
 Usually occurs as the result of
anemia.
 Therapy for anemia includes:
o Supplemental iron
o Packed red cell transfusion.
The Harlequin Sign
 A newborn who has been lying on
his side appears red on the dependent
side
of the body and pale on the upper side,
as if a line had been drawn down the
center of the body.
 Occurs because of immature blood
circulation
 No clinical significance
 Fades immediately if the infant’s
position is changed or the baby kicks
or
cries.
Birthmarks
Mongolian Spots
 Collections of melanocytes that
appear as gray patches across the
sacrum or
buttocks and possibly on the arms and
legs of newborn.
 Occur most often in children of
Asian, Southern European, or African
ethnicity.
 Disappear by school age without
treatment.
Hemangiomas
 Vascular tumors of the skin
 Types:
o Nevus flammeus
 Benign macular purple or dark-red
lesion (Port-wine stain)
 Light-pink patches: stork bites or
telangiectasia
o Infantile hemangiomas (Strawberry
hemangiomas)
o Cavernous hemangioma
General Appearance
Vernix Caseosa
 White, cream cheese like substance
that serves as a skin lubricant.
Lanugo
 Fine, downy hair that covers a term
NB shoulder, back, upper arms and
possibly the forehead and ears.
 Post term infants rarely have lanugo
at birth.
 Term infants, have a generous
supply of lanugo at birth.
 By 2 weeks of age, it has totally
disappeared
Desquamation
 Within 24 hours after birth, the skin
of most newborns begins to dry.
 The dryness is particularly evident
on the palms of the hands and soles of
the
feet and results in areas of peeling.
 This is a reaction to suddenly living
in an air-filled rather than a liquid-
filled
environment.
Erythema Toxicum
 Pink popular rash, commonly found
on the thorax, back buttocks and
abdomen.
 Sometimes called a flea-bite rash
because the lesions are so minuscule.
 Presents on the skin of most term
newborns
 Appears in 1st to 4th day of life and
subsides after several days.
 Caused by the newborn’s
eosinophils reacting to the rough
environment of
sheets and clothing rather than a
smooth liquid against the skin. It
requires no
treatment
Milia
 Tiny white papules on cheeks, chin,
and nose.
 Result from immature sebaceous
glands
 Disappear by 3 to 4 weeks of age as
the sebaceous glands mature and the
plugged or unopened sebaceous gland
drain.
Skin Turgor
 Grasp a fold of the skin between
your thumb and fingers and evaluate if
it
feels elastic. When released, the skin
should fall back to form a smooth
surface.
 Severe dehydration: skin will not
smooth out again but will remain as an
elevated ridge
 Poor turgor is seen in:
o Newborns who suffered malnutrition
in utero
o Newborn who have difficulty
sucking at birth
o Newborn who have certain
metabolic disorders
The Head
Fontanelles
 Spaces or openings where the skull
bones join.
 Fontanel should be flat and firm.
 Anterior fontanel
o Located at the junction of the two
parietal bones and the two fused
frontal bones
o Diamond shape
o Measures 2-3cm in width and 3-4 cm
in length
o Closes at 12-18 months
o Can be felt as a soft spot
o Should not appear:
 Indented- sign of dehydration
 Bulging- sign of increased
intracranial pressure
 Posterior fontanel
o Located at the junction of the
parietal bones and the occipital bone.
o Triangular shape
o Measures 1-2 cm in length
o Closes at 2 months
Skull Sutures
 Separating lines of the skull
 Should never appear:
o Widely separated- Suggests
increased intracranial pressure.
o Fused- It will prevent the head from
expanding with brain growth.
Molding
 Overriding of cranial bones at birth
because of the extreme pressure
exerted
on the head during passage through the
birth canal.
 Resolve within a few days after
birth.
Caput Succedaneum
 Edema of soft scalp tissue that
forms on the presenting part of the
head.
 Occurs in cephalic births
 The edematous area is present
beneath the scalp and it crosses the
midline of the skull.
 The edema is gradually absorbed
and disappears within several days. No
treatment is needed.
Cephalohematoma
 Collection of blood between the
periosteum of a skull bone and the
bone
itself.
 Caused by rupture of a periosteal
capillary because of the pressure of
birth.
 Appears black or blue because of
the presence of coagulated blood
underneath the periosteum.
 Confined to an individual bone, so
the associated swelling stops at the
bone’s
suture line.
 It may take weeks for the blood
under the periosteum to be absorbed,
subside
without treatment.
 As the blood breaks down, the
infant needs to be observed for
jaundice that
can occur from the large amount of
indirect bilirubin that may be released
Craniotabes
 Localized softening of the cranial
bones probably caused by pressure of
the
fetal skull against the mother’s pelvic
bone in utero.
 The skull is so soft that the pressure
of an examining finger can indent it.
The
bone then returns to its normal contour
after the pressure is removed.
 The condition corrects itself without
treatment after a few months as the
infant
ingests calcium from milk
 Normal if seen in a newborn but
would be pathologic in an older child
or adult
Observe for Jaundice...
As the blood breaks down, large
amount of indirect
bilirubin that may be released.
The Eyes
Inspect the eyes of a newborn...
Lay the infant in a supine position and
lift the head; this
will cause the newborn to open his or
her eyes.
 Eyes should appear clear, without
redness or purulent discharge.
 Absence of tears: Lacrimal ducts
fully mature until about 3 months of
age.
 Lids usually edematous and remains
for the first 2 or 3 days until the
newborn’s kidneys are capable of
evacuating fluid more efficiently.
 Iris color: Look gray or blue;
surrounding sclera may appear light
blue due to
its thinness. The iris will assume its
permanent color between 3 and 12
months of age.
 Pupil appears dark.
o White pupil suggests the presence of
a congenital cataract, glaucoma,
retinoblastoma, or other eye disorder
and should be reported
 Cornea appears round and
proportionate in size to an adult eye.
o Cornea that appears larger than usual
may be the result of congenital
glaucoma
Subconjunctival hemorrhage on the
sclera
 Ruptures conjunctival capillary, as a
result of pressure during birth.
 Appears as a red spot on the inner
aspect of the eye, or as a red ring
around
the cornea.
 Requires no treatment, and is
completely absorbed within 2 or 3
weeks.
The Ears
 Pinna in line with outer canthus of
the eye
o Low set ears are found in infant with
chromosomal abnormalities,
particularly trisomy 18 and 13.
 Pinna flexible, cartilage present
Hearing screening...
Done using optoacoustic emissions test
or automated
auditory brainstem response test.
While waiting for a hearing
examiner... Try this...
Infants can be tested by ringing a small
bell held about 6
in. from each ear. A hearing infant will
blink, attend to the
bell’s sound, and possibly startle.
The Nose
 Tends to appear large for the face.
 Nasal Patency

Test for Choanal Atresia
(blockage at the rear of the nose)
Close the infant’s mouth while
compressing one naris at a
time with your fingers. Note any
distress with breathing.
The Mouth
 Mouth should open evenly when a
newborn cry.
o One side of the mouth curves more
than the other, suggest facial nerve
injury.
 Intact, high arched palate
 Uvula in midline
 Presence of one or two Epstein
pearls
o Small round, glistening, well-
circumscribed cysts
o Seen on the palate from extra
calcium that was deposited in utero.
o Insignificant, require no treatment,
and will disappear spontaneously
within a week.
 Natal teeth
o Teeth present at birth
o Evaluate for stability, if loose, they
are usually extracted to prevent
possible aspiration during feeding.
The Neck
 Neck appears short with creased
skin folds.
 Head should rotate or turn freely on
it.
o Rigid neck suggests congenital
torticollis, caused by injury to the
sternocleidomastoid muscle during
birth.
 Trachea appears prominent on the
front of the neck.
 Thymus gland appears enlarged
because of the rapid growth of
glandular
tissue early in life.
The Chest
 The chest averages 2 cm (0.75 to 1
in.) smaller in circumference than the
head circumference.
 Clavicles appears straight and feel
smooth.
o Crepitus (crackling) or separation of
one or both clavicles suggests a
fracture occurred during birth
 Supernumerary nipple may be
present.
 Breast enlargement in both female
and male newborns happen because of
the influence of maternal hormones
during pregnancy. As soon as the
hormones are cleared engorgement
will subside.
Witch’s milk...
Thin, watery fluid secreted by the
newborn’s breast.
as the hormones are cleared from the
infant’s system
(about 1 week) fluid will subside.
 Respirations are normally rapid but
not
distressed. 30 to 60 breaths/min
 Retraction- drawing in of the chest
wall
with inspiration
o Should not be present.
o If present, the infant is using such
a strong force to pull air into the
respiratory tract that he or she is
pulling in the anterior chest muscle
as well.
o Sign of respiratory distress
o Immediate help such as oxygen or
mechanical ventilation is needed.
 Lung sounds often reveals rhonchi
—the sound of air passing over mucus.
o Happened because a newborn’s lung
alveoli open slowly over the first
24 to 48 hours and the newborn
invariably has mucus in the back of
the throat.
The Abdomen
 Contour of the abdomen looks
slightly protuberant.
o scaphoid or sunken appearance
suggests missing abdominal contents
or a diaphragmatic hernia
o Diaphragmatic hernia- bowel or
other abdominal organs positioned in
the chest instead of the abdomen
 Bowel sounds should be present
within 1 hour after birth, it shows the
bowel
is beginning peristalsis.
 Liver: palpable 2-3cm below right
costal margin
 Spleen: palpable 1 to 2 cm below
the left costal margin
 Kidneys: palpable 1-2 cm above
umbilicus.
o Small kidney suggests decreased
function
o Enlarged kidney suggests a
polycystic kidney or pooling of urine
from a
urethral obstruction.
 Stump of umbilical cord appears as
a white, gelatinous structure marked
with the blue and red streaks of the 1
umbilical vein and the 2 arteries.
o No bleeding at the base and it should
not appear wet.
 Moist or odorous cord suggests
infection.
 Moistness at the base of the cord
also may indicate a patent
urachus, which requires surgical
repair. Urachus is a narrow
opening that connects the bladder and
the umbilicus.
Elicit an Abdominal Reflex...
Stroking each quadrant of the
abdomen with a finger will
cause the umbilicus to move or “wink”
in that direction. This superficial
abdominal reflex, a test of spinal
nerves T8 through T10, is usually
present at birth, but may not be
observable until it is stronger at about
the 10th day of life
The Genital Area
The Male Genitalia
 Scrotum usually large, edematous,
pendulous, and covered with rugae;
usually highly pigmented in dark
skinned newborns
 Testes palpable in each scrotum
o If one or both testicles are not
present, it suggests presence of a
condition called Cryptorchidism.
o Caused by:
 Agenesis- absence of the testes
 Ectopic testes- the testes are present
in the abdomen but
cannot enter the scrotum because the
opening to the scrotal sac
is closed
 Undescended testes- the vas
deferens or artery is too short to
allow the testes to descend.
Palpating the testes...
Press the non-dominant hand against
the inguinal ring
before palpating the testes, so they do
not slip upward and
out of the scrotal sac as you palpate.
Elicit a Cremasteric Reflex...
When the skin on the internal side of
the thigh is stroked,
the testis on that side moves
perceptibly upward. The
response is indication that spinal
nerves T8 through T10
are intact, although it may be absent
before 10 days of
age when nerve stabilization is
complete.
 Penis appears small, approximately
2 cm long.
 Urethral opening at the tip of glans
penis.
o Not on the dorsal surface -Epispadias
o Not on the ventral surface -
Hypospadias
The Female Genitalia
 Vulva appears swollen, because of
the effect of maternal hormones during
intrauterine life.
 Some female newborns have
Pseudomenstruation.
o Blood tinged mucus vaginal
secretion
o Caused by maternal hormones,
disappears in 1 or 2 days
The Back
 Spine intact, no openings, masses or
prominent curves
Maintained position...
 Newborn assumes the position
maintained in utero for
days after birth, with the back rounded
and arms and legs
flexed across the abdomen and chest.
 Baby born in a frank breech position
tends to straighten
the legs at the knee and bring them up
next to the face.
 Baby born in a face presentation
sometimes simulates
opisthotonos (backward arching of the
spine) for the first
week because the curve of the back is
concave.
 Patent anus
o Imperforate anus- anus covered by a
membrane
o Note the time after birth when the
infant first passes meconium.
The Extremities
 Complete fingers and toes
o Polydactyly- extra fingers
o Syndactyly- webbing between
fingers;
o Phocomelia (hands or feet attached
close to trunk)
o Hemimelia (absence of distal part of
extremity)
 Full range of motion
 Nail beds pink, with transient
cyanosis immediately after birth
 Creases on anterior 2/3 of sole
 Sole usually flat
 Symmetry of extremities
 Equal bilateral muscle tone
(especially resistance to opposing
flexion)
Breastfeeding
Advantages of Breastfeeding for
Women
 Lactational Amenorrhea Method of
family planning
 Maternal and child bonding is
fostered
 Aids in mother’s uterine involution
 Reduces the cost of feeding and
preparation time
Advantages for Infants
 Breastmilk contains:
o Immunoglobulin A (IgA)- binds
large molecules of foreign
proteins, such as viruses and bacteria,
keeping them from being
absorbed from the GI tract.
o Lactoferrin- interferes with the
growth of pathogenic bacteria
o Lysozyme- actively destroys bacteria
by lysing (dissolving) their
cell membrane.
o Leukocytes- provides protection
against common respiratory
infectious invaders
o Macrophages- responsible for
producing interferon (protein that
protects against viruses).
o Bifidus Factor- growth promoting
factor for the beneficial bacteria
Lactobacillus bifidus. L. bifidus
decrease incidence of diarrhea.
o High in lactose- easily digested sugar
that provides ready glucose
for rapid brain growth
o Linoleic acid- essential fatty acid for
skin integrity
o Less sodium, potassium, calcium,
and phosphorus than formulas.
o Better balance of trace elements,
such as zinc.
o Ideal electrolyte and mineral
composition for infant growth
Preferred food for baby...
It is universally agreed that human
milk is the preferred
food for newborns because it provides
numerous health
benefits to both a mother and an
infant; it remains the
ideal nutritional source for infants
through the first year of
life.
The average breast milk quantity a
mother may
produce...
 37 ml (7 to 123 ml) within the first
24 hours
 500 ml by day 5
 750 ml/day by month 3
 800 ml/day by month 6.
Breastfeeding Reminders
 Mature breast milk may appear thin
and blue-tinged in appearance.
 Newborns should be fed with all
feeding cues, including mouth opening
and bringing hands to mouth.
 Wash hands before breastfeeding
 Women should avoid soap on the
nipples as it may lead to dryness and
skin breakdown.
 Stimulate the newborn’s rooting
reflex by brushing the infant’s cheek
with
a breast nipple. The newborn will then
turn toward the breast.
 If the latch is painful, properly take
the newborn off the breast while the
newborn is sucking.
o Insert a clean finger in the corner of
the infant’s mouth or pull
down the infant’s chin to release
suction.
Positions a mother may use when
breastfeeding
 Side-lying position- permit the
mother to rest while feeding.
 Football hold- use by mother who
had a cesarean birth
o Also helpful if the baby is having
difficulty latching due to large
breasts that obstruct the mother’s view
or less prominent nipples
that provide little palate stimulation
Burping the Breastfed Baby
 Burp newborns after they have
emptied the first breast and again after
the
total feeding to help evacuate air from
their stomachs.
 Technique:
o Place the baby over one shoulder and
gently patting or stroking the
back is a time-honored position.
o Hold the baby in a sitting position on
the lap and then leaning the child
forward against one hand, with the
index finger and thumb supporting
the head, is often the best position to
use. This position provides head
support and leaves the other hand free
to pat the baby’s back.
Engorgement
 Breast distention, accompanied by
hardness, and tenderness, and the skin
may appear red, tense, and shiny
 Caused by vascular and lymphatic
congestion arising from an increase in
the
blood and lymph supply to the breasts.
 Temporary and should begin to
subside after 24 hours.
 Relieving engorgement:
o Empty the breasts of milk by having
the infant feed more often
o Moist heat applied to both breasts or
standing under a warm shower for
a few minutes before feeding,
combined with massage to begin milk
flow, often promotes breast softness so
a newborn can suck.
Sore Nipples
 Painful nipples
 Management:
o Apply a few drops of breast milk to
the nipples after feeding and gently
massaging it into the areola. The
components of breast milk have
healing properties.
 Not contraindicated to breastfeeding
as long as a proper latch is obtained.
Formula Feeding
Mothers should use commercial
formulas for feeding if they choose not
to
breastfeed.
Types:
 Modified milk based- used for the
majority of newborns
 Soy based- devised for infants who
are allergic to cow’s milk protein
 Elemental- used for infants with
protein allergies or fat malnutrition.
 Lactose-free formula- used for
newborns with lactose intolerance or
galactosemia (inability to use sugar)
Commercial formulas are supplied in
four separate forms:
 Powder that is prepared by adding
water as directed- least expensive
 Condensed liquid that is diluted
with an equal amount of water
 Ready-to-feed, which requires no
dilution. Does not need refrigeration or
preparation, but it is the most
expensive type.
 Individually prepackaged and
prepared bottles of formula
Calculating a Formula’s Adequacy:
To calculate the adequacy of a
formula, the following may be used:
 Step 1: The total fluid ingested for
24 hours must be sufficient to meet the
infant’s fluid needs: 75 to 90 ml (2.5 to
3 oz) of fluid per pound of body
weight (150 to 200 ml/kg) per day.
step 2: The number of calories
required per day is 50 to 55 per pound
of body
weight (100 to 120 kcal/kg).
***Commercial formula contains 20
calories per ounce
Example:
1. Calculate the adequate volume of
formula feeding for a 7 pounds’ infant
7lbs X (2.5 to 3 oz) = 17.5 to 21 oz per
day
17.5 to 21 oz / 6 feedings = 3 to 3.5 oz
for each feeding
(17.5 to 21 oz) X 20 calories = The
baby receives 350 to 420 calories per
day