CHARLES & BABY FLORENCE Setting: As Charles improves he is finally given the good news that he is ready for discharge. He is just settling in at home when a representative of CYFS calls to explain that Charles' cousin has been admitted to an inpatient mental health facility following a post partum crisis where her three week old baby’s safety was in question. Charles is asked to take over temporary custody of Florence so her mother can get well. After lengthy discussions with Lisa and their daughters, the family agrees as it is obvious there is no other family member able to care for Florence. In a strange twist of events Charles and Lisa seem happy in each others company as they prepare a room for Florence who is arriving at 5 pm tonight. Action point: How would you recognize normal “baby blues” at day four over post-partum depression? Different to post natal depression Feeling a bit down Loss of interest in usual activities that make you happy e.g. visiting friends Usually begin to feel better within a few weeks Florence was born by NVD on August 10, 2010. Throughout the pregnancy the mothers fundal height had matched her due date and Florence was considered to be a term baby. Her mother received good antenatal care and even met with her LMC prior to getting pregnant to discuss pre conceptual care and her lack of Rubella titres. There was never any question of foetal alcohol syndrome and Florence developed normally in utero. The pregnancy progressed well with Florence being born after a nine hour labour. Florence's mother does not know who Florence's father is and she has been estranged from her immediate family since she was 16. She has kept in touch with Charles as he was the only family member she felt comfortable with. The first sign that there was a possible health problem was when Florence's mother panicked and reacted negatively to her first meconium motion. The LMC became increasingly worried about Florence's mothers coping and Florence's safety over the next three weeks and when she arrived to find Florence being put into a roasting pan with vegetables prepared and placed neatly around her The LMC arranged for a multiple-sectorial plan of action which resulted in Charles and Lisa becoming temporary custodians. Action point: Complete the following glossary: CYFS – child youth and family Pre conceptual – before conceiving Ante natal – before birth NVD – normal vaginal delivery Postpartum – after birth LMC – lead maternity career Term baby – baby that is 40 weeks gestation Fundal height – a measure of the size of the uterus to measure the length and height of the baby Foetal alcohol syndrome – when a baby is exposed and negatively affected by alcohol during pregnancy In utero – in uterus Florence is handed over to Charles and Lisa by the CYFS staff and the LMC is there as well to explain Florence's development to date and to demonstrate how to mix her feeds. While there is a small amount of frozen breast milk available, the LMC explains Florence will be on complete artificial feeds by the end of the week. She explains Florence's mother had none of the usual discomforts of pregnancy and she also outlines that Florence was never harmed, developed normally following birth and apart from her initial weight loss at day three, she has gained weight at each weigh. Action point: Match the discomforts of pregnancy with the associated probable cause and possible treatment (worksheet available in eMIT folder). Lisa is concerned about the weight loss and not wanting to appear ignorant, she goes to her own daughters’ plunket books to find more information. What will Lisa discover in relation to the initial weight loss? Initial weight loss is normal but should pick up after a few weeks. If it doesn’t you should visit your GP. Charles asks how to best thaw the breast milk? Uncover professional and public opinion on frozen breast milk including thawing, effectiveness, expiry dates and methods of expressing milk. It will keep for 3-6 months in the fridge freezer Should be thawed in fridge or in warm water It is not safe to re heat or refreeze milk Should be heated in a cup of boiled water. Check on wrist. One of Charles work friends calls in and is shocked to find Charles in new parent mode. He comments that Florence seems to be doing all the things his daughter was doing at four weeks of age. Action point: Outline the characteristics of a normal, term, four week old baby, include reflexes, measurements and average weight gain. 150 grams per week Smiles Baby sounds Should close to eyes to bright lights Lisa and Charles become concerned about Florence's bowel movements. when she arrived two weeks ago he had mustard colored stools and went frequently, requiring many nappy changes per day. Over the past two weeks the bowel movements have changed and Florence now appears to strain when passing a stool which seems to be pale and hard. Action point: Give an overview of what has happened to Florence 's elementary system. Will you be reassuring Lisa and Charles or rushing Florence to the doctor? Reassure, it is pretty normal for babies at some stage to get constipated Try extra water or pure prune juice or apple juice (5mls in 50mls of water) Lisette and Franchesca notice an indentation in the top of Florence 's skull. Action point: Explain this indentation to Lisette and Franchesca with a full explanation of how long it will be present and appropriate treatment/handling of the indentation. Include any changes that may be evident if Florence is unwell and dehydrated. Fontanelle – should be open 9 -14 months Is delicate It is so that the brain has room to grow Look for signs of sunken fontanelle or buldging and if so contact doctor asap Action point: Charles is concerned that Florence is not receiving any breast milk. His own mother fed him on cows milk and he asks you about swapping Florence's infant formula for cows milk. Action point: Develop a teaching plan for Charles that describes the - differences between cows milk and breast milk - nutritional information about cows milk, infant formula and breast milk - types of infant formula available currently on the market with rationale for their selection for Florence - safe mixing of infant formula Cows milk doesn’t have the same nutritional value of breast milk or immunity Karicare, S26 Gold, NutraGold Put powder is first, leveled with a knife and measured accurately, add cooled boiled water and mix well Charles and Lisa decide to join a coffee group for new parents so that as Florence grows she will have some contact with other young children and they can meet local parents. They enjoy the weekly meetings and one mother says she is pregnant again. She asks Lisa if it is true that she will feel this baby move sooner than she felt her first baby move. She thinks the word her midwife used was "lightening" - Action point: Prepare a teaching plan for the coffee group that outlines - warning signs of pregnancy, what would cause a pregnant woman to seek help urgently from her LMC Pain, bleeding - use this opportunity to educate the coffee group about contraception options for breast feeding women Condoms You can smell that one or more of the participants of the coffee group are smokers and you become concerned when you hear a discussion that implies smoking is a good way to ensure you have a small baby that will be easier to deliver. Action point: If you would like to see a birth the following youtube clips are available: Caesarian section: http://www.youtube.com/watch?v=xyn48VnRYUY NVD: http://www.youtube.com/watch?v=jd4lQjz2uOM&feature=search