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
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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
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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