what NIPE risk factors are present in Cat’s case?
- smoking
- alcohol
- cystic fibrosis carrier (partner)
- GBS
- breech
- small eyes
what antibiotics given for GBS?
- For women who require or have agreed to IAP, Benzylpenicillin should be administered
- 3 g intravenous Benzylpenicillin immediately after onset of labour or SRM
- 1.5 g IV 4 hourly until birth.
- IV antibiotics ideally administered 4 hours prior to birth
what drug is given to women with GBS who are allergic to penicillin?
- If sensitive»>Clindamycin 900mg TDS for IAP
- Resistant to Clindamycin should administer IV Teicoplanin
- Teicoplanin dose: 12mg/per kg (maximum = 800mg) every 12 hours for 3 doses and then 24 hourly until birth
what is the dose of lactulose?
Lactulose – 15ml B.D
how often do you apply clotrimazole?
2-3 times a day for two weeks, thin layer
how can recurrent thrush impact Cat’s holistic care?
- Thrush infection is also bothering Cat – this can feel quite irritating and sore which can then be impacting Cat’s emotional health and she may feel upset and annoyed about the recurrent thrush. Which can impact her social health and she may not feel up to going out for walks etc. then in turn her mental health.
how can previous PTSD and PND impact Cat’s holistic mental health?
this puts Cat at higher risk of experiencing this again. Cat may be aware of this or may be thinking about her previous postnatal experience and be worried that this may return. Mentally, Cat may experience more anxiety and feel emotionally overwhelmed. So things like skin to skin will help with this. Consider perinatal mental health referral. Ensure that health visitor is involved even though they properly take over day 10. It is important they are aware.
how can moving home impact holistic health?
– Cat is adopted therefore his limited family support of her own. Even though she has moved to eb closer to Dave’s family she may not get along with his family or be close. Therefore, her social network is very small. This can make her feel isolated which can then impact her emotional health making her feel very lonely, potentially overwhelmed, anxious. Which can have long term impacts on her mental health. Referring her to support groups even like breast buddies can help her feel not alone. Things like breast buddies is good for social groups and any other groups postnatal available. Referrals can include Home start and third sector organisations, which are volunteers who meet with mums and help provide emotional support and social support also.
how can daughters weight loss impact Cat’s holistic health?
due to Evie’s weight loss. This may impact her physically if she isn’t attaching Evie properly causing her pain or then. Cat may be questioning whether she can actually breastfeed. This can impact her emotionally, as Evie is not effectively feeding and now potentially developing jaundice which can be quite concerning and a worrying time for parents. This can then impact her mental health as she may be very anxious about Evie and breastfeeding which can then impact her oxytocin levels. Additionally, this can cause relationship or boning issues (social) impacts as this is a worry time and relationship break downs can be caused because of this. Hopefully reassurance from paeds and infant feeding team can help Cat’s anxiety.
how can dave being a cystic fibrosis impact holistic health?
– can be an anxious time to see if baby is impacted by this. Referring to genetic counselling and paeds to provide support with this. Or check notes and see if there is a care plan in place already. Ensure that paeds are aware and that Cat has been in contact with genetic counselling.
how can alcohol impact Cat’s holistic care?
physically – when drunk, Cat may be feeling unwell, hungover which make her incapable for looking after her baby safely. She may not be looking after herself such as cleanliness, medications etc. mentally, alcohol is a depressive therefore it can heighten her feelings such as if she was experiencing baby blues. May make this prolonged. And her emotional health may be impact she may feel unable to cope. She may not be in full control of her emotions which then can impact her social health as her relationships may eb breaking down etc. Discussing this with cat and if she’d accept the help then I can refer her to AA and Women for sobriety. As well as liaise with the health visitor to provide Cat support with stopping drinking
how do we help Cat with feeding 10.5% weight loss?
- beginning
- care plan for >10%
- P+A
- Hand expression
- Effective Feeding
- Referrals
how do we BEGIN with a 10.5% weight loss?
- Women centred approach demonstrated throughout (1)
- Observing and listening during conversations (1)
- Take a history
- Discusses hands off approach (1)
- Clear relevant information shared (1)
- Mentions use of leaflets, analogies, props (1)
- Identify signs of instinctive behaviour in baby:
- Rooting (1)
- Head bobbing (1)
- Mouthing the nipple (1)
- Hands in the mouth
- …and helps mother to recognise them 1
what is the CARE PLAN for a 10.5% weight loss?
- History taken to exclude infection or illness.
- Performed a breastfeeding assessment – BFI tool and observe a feed
- Make a plan with the parents that is SUSTAINABLE and supportive of babies clinical needs and mothers milk supply
- Promote lots of skin to skin
- Optimise position and attachment and ensure baby is feeding 8/24hrs - this may include waking up for feeds
- Consider switch feeding and breast compressions (squeezing and holding during feeds – shouldn’t be painful)
- Express EBM after every feeds via cup if possible
- Supplementation with formula should only be considered If EBM volumes are low and do not improve after 2-3 expressions.
- 3 hourly feeds with EBM afterwards
- Reweight baby in 24 hours
- Consider additional support from breastfeeding team or Infant Feeding Advisor and/or paediatric review (depending on local policy)
- If no or minimal weight increase or further loss, see plan 3 and refer to local trust guidelines.
- Compassion, encouragement and reassurance and value all breastmilk that baby has received
How do we help with P+A?
- Baby held close (1)
- Baby held/supported with head and body inline (1)
- Baby’s head free to tilt back (1)
- Baby held with nose opposite nipple (1)
Component of Assessment - Attachment Points offered Achieved - Watch for baby to have a wide open mouth (1)
- Mother moves her baby to her breast with head tilted back, chin leading (1)
- Bottom lip touches breast well away from the base of the nipple (1)
- Nipple aimed towards the rear of the roof of the baby’s mouth (1)
how do we help with hand expression?
- Explains why hand expressing might be useful (1)
- Describes an approach to teaching the practical skills of hand expressing
- which demonstrates a woman centred approach (1) - – stimulates oxytocin which triggers the let down reflex, can help collect ebm, can help baby find the nipple and encourage to feed, might be useful to decrease encouraged breasts or mastitis.
- Describes skill using a diagram or model of the relevant anatomy (1)
- Explains the importance of stimulating oxytocin (1) - oxytocin is the hormone that ejects milk. It produces the ‘let down reflex’ which is controlled by the mother seeing, feeling, smelling her baby etc.
- Suggests things that will help with oxytocin:
- Having baby near (1)
- Gentle breast massage (1)
- Use of something to remind mother of baby (1)
- Explain to a mother how to express milk:
- Place fingers 2-3 cm back from the base of the nipple (1)
- Shifting her fingers position when needed (1)
- Thumb in C shape (1)
- Compress and release in a steady rhythm (+/- pressing back first) (1)
- Avoid sliding fingers on skin (1)
- Move round breast once flow slows (1)
- Once flow slows/ceases, move to other breast (1)
how do we assess effective feeding?
- Mother comfortable/pain free during feed (1)
- Baby’s mouth is wide open (1)
- Baby’s chin indents the breast (1)
- Baby’s cheeks are full and round (1)
- Nipple aimed towards the rear of the roof of the baby’s mouth (1)
- Sucking is appropriate to age of baby:
- Usually rapid initially, then deep (1)
- Rhythmic with pauses (1)
- 2:1 suck swallow ratio
- Audible swallows (1)
- Areola: If any is visible, then more will be visible above the baby’s top lip (1)
- The baby is contented and stays on the breast (1)
who would we consider involving in a 10.5% weight loss?
Consider referral to breastbuddies/infant feeding team and contact paeds about weight loss and jaundice. Run your plan by them and so they are aware you will contact them the following day to see if additional care is needed.
why is alcohol a risk factor?
- Small head (when checking OFC)
- Small or large eyes
- IUGR (problems with breathing, feeding, trouble keeping a steady body temperature, low blood sugar level (hypoglycaemia), problems fighting off infections, neurological problems – reflexes)
- Hearing disorders
- Shallow philtrum
- Thin upper lip
- Congenital abnormalities - cleft lip, palpate, heart defects
why is smoking a risk factor?
- Low birth weight
- Increased risk of asthma – recommend BF
- Increased risk of orofacial cleft
why is GBS a risk factor?
Look out for early onset GBS as the NIPE examination is in the first 3 days of life.
Checks NEWS
Check for:
- Fever
- Grunting and breathing difficultieS
- Tachycardia
- Irritability
- Lethargy
- Cyanosis or pale
- Feeding difficulties
why is breech a risk factor?
- more likely to have hip dysplasia
- need hip USS
why is cystic fibrosis a risk factor?
Due to mums history of being unaware of history and along with dad being a carrier for cystic fibrosis then it is important to refer to genetic counselling.
- Salty sweat, parents may notice a salty taste when kissing their child.
- Poor growth and weight gain
- Constant coughing and wheezing
- Thick mucus or phlegm
- Greasy, smelly stools that are bulky and pale coloured.
3 holistic care needs…
- social isolation - moved home - home start
- previous PTSD and depression - perinatal mental health
- big weight loss - infant feeding, breastbuddies, paeds
- recurrent thrush - GP who may then refer to sexual health
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Genetics and Genomics50
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NIPE 1167
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NIPT Screening89
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Screening and Congenital Abnormalities10
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Rhesus Incompatibility25
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Infections73
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Medicine Management43
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Holistic Care29
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Pharmacology5
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Perineal Repair84
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Pharmacology 217
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Breastfeeding and Medicines17
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Caseload37
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Infant Feeding41
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NIPE Summary25
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Pharmacology - Skills40
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Perinatal Mental Health60
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Health Promotion177
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Epigenetics24
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Child Development44
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Optimising Physiology82
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Quiz81
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Antenatal Education16
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Pharmacology 4108
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Peer Education11
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Kirsty24
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Therapies57
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OSCE Checklist29
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Interprofessional Working4
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Health Visitor12
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Nantale21
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Cat24
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Chloe25
