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POSTPARTUM
AND LACTATION
GROUP 4
Shofiyatil Laily
011511223003
011511223008
011511223018
011511223021
Resti Mutya Y.
011511223026
Bahriyatul H.
011511223045
CHAPTER 1
After childbirth, women go through the puerperium,
the period to restore the body in normal conditions.
This period is also called post-natal or post-partum.
Breastfeeding to the newborn is an important thing
because it has great benefits for both mother and baby.
In a survey of 15,341 adolescents ages 9 to 14 (8,186
girls and 7,155 boys) found that those who were fed
predominantly breastmilk in the first six months of life
were 22% less likely to be overweight 9-14 years later.
CHAPTER 2
MIDWIFERY CARE
IN POST PARTUM
LACTATION
MIDWIFERY
CARE IN POST
PARTUM
Post-Natal Period
The post-natal period is the
time which the body returns to
normal. Post-natal lasts for about
six weeks.
Post-Partum Care
There are also routine cares that
should be done by midwife to
mother, namely:
Vital Sign
Bladder
Breasts
Fundus of
uterus
lochia
Perinatal
care
mobilizati
on
Advice
Vital Sign
pain.
Check the blood pressure for the first two days. If normal, check
again at the end of the post-partum period unless otherwise
indicated.
Breasts
Fundus of
uterus
about 10 days. The level of the fundus should be checked daily (or on
each visit). The day after delivery, it is about one finger each
succeeding day. It should always be measured after the bladder has
Some
mothers have difficulty passing urine after delivery
been
emptied.
either because of a loss of the sensation of fullness or
Bladder
lochia
Perinatal
care
mobilizati
on
Advice To Mother
DIET
EXERCISES
PREVENTING
INFECTION
REST
OCD
Postpartu
m anxiety
Postpartu
m
depression
(PPD)
Postpartu
m
psichosis
(PPP)
Baby blues
feelings
of
sadness
after
childbirth.
Also
called
postpartum
Postpartu
m
depression
(PPD)
Postpartu
m
psichosis
(PPP)
Postpartu
m anxiety
OCD
After Pains
Constipation
Hemorrhoids
Swollen
Breasts
Cracked
Nipples
Min
or
Dis
ord
ers
Of
Post
part
um
Mot
her
Mastitis
Puerperal Sepsis
Complicatio
ns
Thrombophebiti
s
Secondary
Hemorrhage
PUERPERALIS
SEPSIS
MASTITIS
THROMBOPHEBITIS
SECONDARY
HAEMORRHAGE
LACTATION
BREASTFEEDING
Exclusive Breastfeeding :
Practice of only giving an infant
breast-milk for the first six
months of life.
Human Milk Composition
Colostrum
present in the breast
during pregnancy
and for about the
first 2 to 4 days after
birth. Though small
in quantity during
the first 24 hours
Transitional Milk
Approximately
7 to 10 days
after delivery
Mature Milk
By 14 days milk
is considered
mature
2.
Lipids,
About 50% of the calories in human milk come from lipids. Human milk contains
omega-3 fatty acids, including docosahexaenoic acid (DHA), important for brain and
retinal development and function. Cholesterol, important to the development of
membranes
3.
Proteins
The total protein content of human milk, 0.9%, milk protein can be divided into two
major components, whey and casein. Milk curd, which forms from the casein when the
milk pH drops below 5.0, is an insoluble calcium caseinate-calcium phosphate
complex.
4.
Carbohydrates,
Lactose, synthesized in the breast, is a disaccharide consisting of
galactose and glucose. At concentration levels of 7.2 g/dl, it is the major carbohydrate
in human milk and is essential as a source of glucose.
5.
Minerals, all minerals needed for newborn and infant growth are present in, and well
7.
8.
9.
Mammary
Development
Lactogenesis and
Psychological
Influences
Oxytocin
Galactorrhea
Newborn
Oral
Developmen
t
Mother
Infant
Suckling
Breathing
and Suckling
Mammary Development
Birt
h
Puberty
Pregnancy
Lactation
Mammary Development
Tabel 2. Hormonal Influences During Pregnancy
Hormone
Function
Prolactin
Human
Placental a. made by the placental
Lactogen (HPL)
b. is actively secreted into maternal circulation starting in the second month of pregnancy.
c. As yet, the role of HPL in lactogenesis is not clear, because it is produced in such large amounts, it may have a
lactogenis effect.
Glucocorticoids
Thyroid
Stimulating a. hormones a promote mammary growth and lactation through a permissive rather than a regulatory role.
Hormone (TSH)
b. play a general role in the health of the mother by regulating metabolic processes. Because the thyroid gland is an
integral part of the complex endocrine system, a thyroid deficiency in the lactating mother can decrease the milk
supply.
Prolactin
inhibitting a.PIF, a hypothalamic substance, etiher dopamine itself or medicated by dopamine, inhibits prolactin secretions.
factor (PIF)
b.Nipple stimulation suppresses PIF and dopamine, causing prolactin levels to rise and the breast to produce milk.
c.Some drugs, such as phenothiazines and reserpine derivatives, increase breastmilk because they also inhibit PIF.
Thyrotropin-releasing
hormone(TRH)
TRH has been thought to increase TSH and prolactin levels. Therefore, TRH is thought to play a role in the control of
prolactin secretion. Recently, however some scientists were unable to conclude that TRH played any role in the release of
prolactin when they measured plasma prolactin and TSH responses to breastfeeding during the first month postparum.
Lactogenesis and
Psychological Influences
Milk comes in or rapidly increases in volume with breast
fullness 24 to 48 hrs after birth, lactation shifts from
endocrin to autocrin control
Quantity and Quality suckling or milk removal that governs
breast milk, not maternal hormones
Suckling
Stimulates
Afferent Impules
Let-down Reflex
Nervous Systems
Oxytocin
Galactorrhea
the
appearance.
full-term
infant
his
characteristic
plump
facial
Suckling
The nipple and its surrounding areola and underlying breast tissue is
drawn deeply into the infants mouth; then the infants lips and
cheeks from a seal. The infants lips are flanged out-ward around
the mothers breast and are minimally involved
The tip of the infants tongue is maintained behind the lower lip and
over the lower gum while the rest of the anterior tongue cups the
areola of the breast.
During the feeding, the mothers nipple and areola elongates into a
teat by suction created within the babys mouth.
The jaw moves the tongue up, compressing the maternal aerola against the infants alveolar ridge
which causes milk to be expressed from the lactiferous sinuses into the infants mouth.
As the anterior portion of the tongue is raised, the posterior tongue is depressed and retracted in
undulating or peristaltic motions, forming a groove that channels the milk to the back of the oral cavity
where it stimulates receptors that initiate the swallowing reflex. This backward movement produces a
negative pressure, similar to withdrawing a piston in an airtight syringe.
Suckling
The infant lowers his jaw, the lactiferous sinuses refill and a new cycle
begins. A rhythm is created by this sequence of vertical jaw movements
and the depression and elevation of the posterior tongue. Each suck
sequence is followed by a swallow. The rapid jaw movement and the
infants tongue and lips stimulate tactile nerve endings in the mothers
aerola, initiating the release of oxytocin from her pituitary gland.
Common Challenges
1. Sore
Nipples
2. Engorgement
5. Plugged Duct
3. Mastitis
6. Fungal Infections
CHAPTER 3
The post-natal period is the time during which the body returns to normal. It last
about six weeks. WHO describes that post-natal period is as the most critical yet the
most neglected phase in the lives of mothers and babies, most death occurs during this
period. Therefore, post-partum care is needed during this period.
Breast milk is a complete food for the new baby. The nutritional profile of breast
milk in terms of calories, vitamins, and minerals is the best for the new baby. Because it
has the perfect propotion of them all. One of the most important skills that a baby and
mother have to learn together is how to position and attach baby to the breast.
REFERENCES
Morris,
SE. 1982. The normal acquisition of oral feeding skills: Implications for
assessment and treatment. New York: Therapeutic Media.
Wesson, Nicky. 1995. Alternative Health Alternative Maternity. Optima
Riordan, J. & Aurberch, Kathleen G. 1993.Breastfeeding and Human Lactation. Jones
and Bartlett Publishers
Cox, Helen. 1971. Midwifery Manual A Guide for Auxiliary Midwives. McGraw-Hill Inc
College of Midwives of Manitoba (CMM) Postpartum Care of Mother and Infant. Dec
2004
Training modules ; Essential Antenatal, Perinatal and Postpartum Care. World Health
Organization 2003
WHO recommendations on Postnatal care of the mother and newborn. October
2013
WHO.http://who.int/globaltargets_breastfeeding_policybrief . accessed on October
17th 2015
http://www.womanshealth.gov/Breastfeeding . accessed on October 18th 2015
http://www.wellstart.org/Lactation-Management-Self-Study-Modules . accessed on
October 18th 2015
www.arhp.org/guide. A Quick Reference Guide for CliniciansPostpartum
Counseling . July 2013
THANK YOU