I conversed with Mrs X her expectations of the puerperium period during my third visit. The Puerperium period is the first six weeks following the childbirth, where mother experiences more physiological changes in the process of returning to her non-pregnant state (Chelmow, 2011). Mrs X mentioned that she expected to have a well-organized house when she returned home. She also expected that she would get more help from family members so that she could rest. But she stated that all had happened quite different from her expectations. The house was not cleaned up to her expectations. She added that she was depressed and restless because of lack of support from both of their (Mrs X and Mr Y) family members and had to rely mostly on their own strength to look after the new born, other children as well as household chores. Women are potential for developing depression after pregnancy due to inadequate support and stressfulevents ("womenshealth.gov," 2010). She also stated that she had experienced a little urine leakage when she became emotional, coughed and sneezed. New Zealand Continence Association (NZCA) states that after having a baby most women experience urine leakage due to less bladder control which is due to stretched pelvic floor muscles during baby delivery (2012).
3b. Father's Experience
Mr Y stated that he used to wake up sometimes at night when the baby cried. Mr Y explained that it was really hard time as they had to look after other children as well as a newborn baby and also doing house hold work. He stated that it would have been a great help if their family members supported in those situations to relieve their stress. Adequate support from family members, friends and communities can reduce stress in that adjustment period http://parenthood.library.wisc.edu/Olson/Olson.html (Nancy Olson, 1998)
3c. appendix 3
Mrs X stated that the care and support provided by her midwife was very satisfactory. Mrs X said, the midwife helped them in many ways. She mentioned that her midwife helped her to practice pelvic floor exercises that could control urine leakage and also discussed with her about contraception to prevent unplanned pregnancies. Mrs X also stated that her midwife used to assess her babies height and weight regularly. Mrs X mentioned that the information provided by Plunket was also really helpful.
3d. The Newborn Baby
The newborn baby needs to be assessed straightaway after birth. The intensions behind the assessment of a newborn baby soon after birth is to know whether the newborn can adjust to the outside environment of the uterus and also to recognize any defects in the newborn so that early interventions can be made to overcome those defects (pilliteri, 2010). Many assessment interventions are done at birth such as; recording the time of birth, which enables the LMC to check whether oxygen is getting to the brain.The Apgar score at one minute and four to five minutes after birth enables the LMC to assess the need for resuscitation. Baseline assessments from which all other measurements are compared are also made. The assessments made to inform the baseline information are; recording temperature, pulse, respirations, blood pleasure, baby's weight and length and assessing baby from head to toe as well as the functioning of all the body systems (pilliteri, 2010). An assessment of the cord clamp to check for any bleeding is also made immediately after birth. Details about the head to toe assessment including the assessment of the systems of the body and the reason for each assessment are attached in appendix 4.
3e.During the process of adopting to life outside the uterus the newborn may undergo many physiological changes. Some of the changes are physiological weight loss, meconium, mongolian blue spots and physiological jaundice. Appendix 5
3f. hearing and vision
3g. Plunket nurse
3h. Please refer to appendix 1 for my learning issue on Puerperium period and the newborn baby.
Infant feeding
4a.Mrs X mentioned that she chose to breastfeed her baby as she did with her other children. Once, she had tried to use breast milk as well as formula for her baby. But she discontinued formula for financial and maintenance reasons. Mrs X mentioned that the choice she made on breast feeding is her natural intension and did not seek advice to make this choice. Mrs X said that she received a breast feeding CD and a booklet from her midwife. But she didn't go through the information as she already had breast feeding experience with her other children.
Breast feeding
4b. advantages and disadvatages appendix 6
"Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development" (WHO, 2012, Para. 1). Advantages of breastfeeding for the baby and the mother and possible disadvantages are attached in appendix 6.
4c. client's exp on BF
Mrs X said she feeds her baby when the baby cries. "I can easily identify that he is in need when he cries" she said. She also stated that she will come to know that her baby is full because he loses the grip of her breast and fall asleep following the feed.
Formula Feeding
4d.A mother is required to know the following things before choosing the appropriate formula for her baby. Mainly, it is important for a mother to know that if she chooses to use formula milk that she use the same type of formula for her baby until 12 months, unless contraindicated by a health professional to change to another formula. It is also important for a mother to identify whether the baby is allergic to formula. Another thing is, mother needs to know that cow's milk formula is best for her baby and needs to get advice from health professionals regarding the best preferable cow milk's formula for the baby. It is also important for a mother to consult health professionals if the baby is allergic to cow's milk formula so that the health professionals (doctors or midwives) can recommend safe alternatives for baby("Feeding your baby infant formula," 2012). It is also necessary for a mother to follow the mixing instructions on the formula tin to know the exact quantity (number of level scoops) of formula needed in the measured water because, adding more or less than required quantity can result in constipation or lacking in nutrients respectively http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Constipation_and_children/$File/Constipation_and_children.pdf.
4e. Feeding equipment such as bottles, teats and other equipmentneeds to be cleansed and sterilised safely and thoroughly as there is risk for newborns to develop bacterial infection in their body (Ministry for Primary Industries, 2012). The process for the safe cleaning and sterilisation of feeding equipment used in making a milk formula is attached as appendix 7.
4f. Mrs X stated that she breast feed her baby all the time and only tried formula for couple of times along with breast milk so she hardly ever noticed how much quantity her baby had with bottles as she breast fed him subsequently.
Introduction of solids
Mrs X mentioned that she introduced solids to her baby in fourth month. She said she mainly offered pureed rice and peer and sometimes little bit of mashed banana that mixed up with breast milk.
My learning issue on Infant feeding is attached to appendix 1.
3. reflection
4. conclusion
Feeding your baby infant formula [Brochure]. (2012). Retrieved from https://www.healthed.govt.nz/resource/feeding-your-baby-infant-formula
Appendix 5: Physiological changes in new born
Physiological weight loss is defined as the weight loss that the newborn loses within five to seven days after birth, usually it is about 5 percent of the initial weight for bottle fed newborn and seven to ten percent in breastfed newborn http://www.americanpregnancy.org/firstyearoflife/newbornweightgain.htm . Most of the newborn babies regain the lost weight within ten to fourteen days period (Crisp & Taylor, 2009).
Mangolian blue spots are slate-gray color patches mostly appear on sacral area of the and possibly on limbs of newborn. Mangolian blues spots are common in darker skin children from african ethnicity and asian. There is no treatment necessary because these spots disappear by school age. Sometimes these spots may be a real concern for parents; they might consider them as bruises from birth injury. So it is important to inform parents about these spots are normal birth spots and disappear by age.
Meconium is the first newborn's fecal substance that is excreted within the 24 hours after birth and it is sticky, thick and greenish in colour (Marie, 2009). Meconium is a collection of different elements such as amniotic fluid, fatty acids, mucus, blood, lanugo, bile pigments and secretions of the intestinal glands. If the infant undergo intrauterine stress, meconium can pass into the amniotic fluid that surrounds the infant, and if the baby inhales the meconium-stained fluid during delivery it can be sucked down into the lungs and it may lead to meconium aspiration syndrome (Papalia, Olds &Feldman, 2009).
Physiological jaundice in newborn is defined as the condition where the red blood cells formed in uterus get destroyed after birth due to higher levels of billirubin and hence the newborn's skin and whitening of eye appears yellowish after 48 hour following birth(reference). This happens when heme and globin are released from broken red blood cells where heme is further broken down into protoporphyrin and this further broken down into indirect billirubin. Indirect billirubin is a fat soluble and cannot be removed through renal system but it can be converted to water soluble and thus excreted as meconium by liver enzymes. Most of the preterm babies have immature liver functioning for first few days, so the indirect billirubin remains inside covering the red blood cells making the skin to appear yellow. This condition is normal in newborns if the indirect billirubin levels are lower than 7mg/100mL. Mothers are encouraged to breastfeed their babies regurlary and more frequently to prevent indirect billirubin through meconium excretion. Mother also needs to expose the baby to sunlight for 10 to 15 minutes. This helps in maturation of liver enzymes.
