Chapter 49 Mothers and Newborns Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Objective SWBAT describe the care of mothers and newborns IOT provide care to this patient population. Drill What are the normal ranges for an adult for oral temperature, heart rate, and respiratory rate?

Drill Answer Oral temperature: 97.6 – 99.6˚F; 36.5 - 37.5˚C HR: 60-100 bpm RR: 12-20 bpm

Caring for Mothers and Newborns Mothers and newborns usually have short hospital stays. Common reasons for home care after discharge include that the mother Has complications before or after childbirth Has health problems Needs help with other young children in the home Had a multiple birth Needs help with meals and housekeeping

Infant Safety and Security Babies cannot protect themselves. Babies depend on others for basic needs. Babies need to feel safe & secure. They feel secure when warm and when wrapped and held snugly. Babies cry: To communicate When wet, hungry, hot or cold, tired, uncomfortable, or in pain Babies depend on others for basic needs. Babies need to feel safe and secure. They feel secure when warm and when wrapped and held snugly.

Infant Safety and Security (cont’d) To promote safety and security: Respond to their cries Feed them when hungry Change diapers as needed Comfort them Talk to them Nursery equipment must be safe and in good repair Babies can become ill quickly. Signs and symptoms may be sudden Be alert to any change in the baby’s behavior Tell the nurse when a sign or symptom began See Chapter 12 for infant safety measures. Follow the measures in Box 49-1 on p. 772 in the Textbook. Use the guidelines in Box 49-2 on pp. 773-774 in the Textbook to check nursery equipment in an agency or home setting. Report to the nurse at once any of the signs and symptoms in Box 49-3 on p. 774 in the Textbook. You may need to measure the child’s temperature, pulse, and respirations. The nurse tells you what temperature site to use. Apical pulses are taken on infants and young children.

Helping Mothers Breast-Feed Breast-feeding (nursing) is feeding a baby milk from the mother’s breasts The baby can feed at the mother’s breast The mother can pump milk from her breasts Breast-fed babies are fed on demand The following signal the end of the feedins: the baby’s sucking slows; the baby pulls off the breast; the baby is no longer interested in feeding. Mothers may need help with hand washing and positioning. Assist as needed. Make sure the signal light is within reach before you leave the room. Provide for privacy. To help with breast-feeding, follow the care plan. Follow the measures in Box 49-4 on p. 775 in the Textbook. Review the Focus on Long-Term Care and Home Care: Helping Mothers Breast-Feed Box on p. 776 in the Textbook.

Bottle-Feeding Babies Formula Ready-to-feed Powdered Liquid concentrate Bottles are prepared one at a time or in batches for the whole day Follow the container directions carefully. Use bottles stored in the refrigerator within 24 hours. Protect the baby from infection. Baby bottles, caps, nipples, and other items must be as clean as possible. The doctor prescribes formula to babies who are not breast-fed. It provides the nutrients the infant needs. When preparing formulas, measure exact amounts. When baby bottles are cleaned, complete rinsing is needed to remove all soap. Review the Focus on Long-Term Care and Home Care: Cleaning Baby Bottles Box on p. 777 in the Textbook. Review the Promoting Safety and Comfort: Cleaning Baby Bottles Box on p. 777 in the Textbook.

Burping the Baby Babies take in air during feedings. Air in the stomach and intestines causes cramping and discomfort. This can lead to vomiting. Burping helps to get rid of the air. Most babies burp mid-way and after a feeding. You pat or rub the baby’s back with circular motions. Do this for 2 or 3 minutes. Burping a baby also is called bubbling.

Diapering Diapers are changed when wet or when stools are present. Breast-fed babies = yellow and seedy-looking stools Bottle-fed babies = yellow to brown stools In the first 1 or 2 days after birth, newborns have meconium stools (a dark green to black, tarry bowel movement). Bottle-fed babies have fewer stools than breast-fed babies. Infant’s fluid balance is upset quickly.

How to change a baby’s diaper https://www.youtube.com/watch?v=E_P8NEHR0hE (2:08)

Umbilical cord

Care of the Umbilical Cord Cord care involves the following: Keep the stump clean and dry. Do not get the stump wet. Keep the diaper below the cord. Give sponge baths until the cord falls off. Do not pull the cord off. Report the following to the nurse: Swelling, redness, odor, or drainage from the stump Bleeding from the cord or navel area Fever Do not pull the cord off, even if looks ready to fall off. Review the Promoting Safety and Comfort: Care of the Umbilical Cord Box on p. 783 in the Textbook.

Circumcision Circumcision is the surgical removal of foreskin from the penis. Prevent urinary tract infections in infants Lower the risk of cancer of the penis Decrease the risk of sexually transmitted diseases Circumcision should not interfere with voiding Heals in 7-10 days Apply petrolatum jelly Observe for signs of bleeding and infection Boys are born with foreskin on the penis. The procedure is usually done before the baby leaves the hospital.

Bathing an Infant A bath is important for: Sponge baths and tub baths Hygiene Good skin care Comfort and to relax babies A time to hold, touch, and talk to the baby Stimulation Sponge baths and tub baths Never leave infant alone!

Weighing Infants The infant’s birth weight is the baseline for measuring growth The nurse uses weight measurements: In the assessment step of the nursing process To measure the amount of breast milk taken during breast-feeding Review the Delegation Guidelines: Weighing Infants Box on p. 787 in the Textbook. Review the Promoting Safety and Comfort: Weighing Infants Box on p. 787 in the Textbook.

Care of the Mother Postpartum means after childbirth Birth - 6 weeks The mother’s body returns to its normal state during this time The mother adjusts physically and emotionally to childbirth The uterus returns almost to its pre-pregnant size. This is called involution of the uterus. If the mother does not breast-feed, she can expect a menstrual period within 3 to 8 weeks. Breast-feeding is not an effective method of birth control. Without birth control measures, the mother can get pregnant again.

Care of the Mother (cont’d) A vaginal discharge called lochia occurs after childbirth Lochia consists of blood and other matter left in the uterus from childbirth Normally, lochia smells like menstrual flow Good perineal care is important Episiotomies (incisions into the perineum) Painful Risk for infection Provide for sitz baths The lochia changes color and decreases in amount during the postpartum period. Lochia increases with breast-feeding and activity. The mother wears a sanitary napkin to absorb the lochia.

Care of the Mother C-Section Some mothers deliver by cesarean section (C-section) The baby is delivered through an incision in the abdominal wall A C-section is done when: The baby must be delivered to save the baby’s or mother’s life. The baby is too large to pass through the birth canal. The mother has a vaginal infection that could be transmitted to the baby. A normal vaginal delivery will be difficult for the baby or mother. The C-section incision needs to heal. Review Chapter 33 in the Textbook for wound healing and wound care.

Mother may have emotional reactions Causes include: Hormone changes Life-style changes Lack of sleep Frequent visits and telephone calls Advice and opinions about parenting The mother can help herself by: Resting when the baby sleeps Taking time for herself and her partner The mother may feel better after a shower, washing and styling her hair, and getting dressed. These can be done while the baby sleeps. Report any sign or symptom listed in Box 49-6 on p. 789 in the Textbook to the nurse at once.

Did we meet our Objective? SWBAT describe the care of mothers and newborns IOT provide care to this patient population.