You are in the postpartum unit where a Day two G1P1 Mother is working hard at breastfeeding her baby. She is concerned that the baby is fussy between feedings. The advice you would give her is:

A) Prolactin:
Prolactin is the primary hormone responsible for stimulating milk production in the postpartum period. In breastfeeding mothers, prolactin levels remain elevated, especially during the first few weeks after delivery, to support lactation. This hormone is released in response to suckling and is essential for maintaining a steady milk supply. Elevated prolactin levels help establish and maintain breastfeeding during the early postpartum period, even as other pregnancy-related hormones begin to decline.

B) Estrogen:
Estrogen levels drop sharply after childbirth, as the placenta is no longer present to produce this hormone. The decline in estrogen is one of the factors that helps initiate lactation. While estrogen rises later during the postpartum period as the body returns to its non-pregnant state, it is not elevated during the immediate postpartum period in breastfeeding women.

C) Progesterone:
Similar to estrogen, progesterone levels fall quickly after delivery. Progesterone is involved in maintaining pregnancy, and its levels decrease significantly once the placenta is delivered. A reduction in progesterone is one of the hormonal changes that triggers the onset of lactation. It does not remain elevated in the immediate postpartum period.

D) Human placental lactogen (hPL):
hPL is produced by the placenta during pregnancy to support fetal growth and prepare the breasts for lactation. However, after delivery, hPL levels decline rapidly because the placenta is expelled. It is not elevated in the immediate postpartum period.

E) Relaxin:
Relaxin is a hormone that helps to soften the cervix and relax the ligaments in preparation for childbirth. Its levels are elevated during pregnancy and drop significantly after delivery. It does not remain elevated in the postpartum period, particularly in breastfeeding women.

A) Caput succedaneum present:
Caput succedaneum refers to the swelling of the soft tissues on the newborn's head, typically caused by the pressure exerted during vaginal delivery. This condition is often seen after a prolonged labor or in cases of vacuum-assisted delivery. It presents as a soft, fluid-filled swelling that crosses the suture lines, which distinguishes it from a cephalhematoma (a collection of blood). This swelling is usually benign and resolves within a few days after birth without intervention.

B) Severe molding present:
Molding refers to the shaping of the newborn's skull bones as they overlap to pass through the birth canal during delivery. It typically presents as elongated or asymmetric head shapes, particularly in the vertex presentation. Severe molding would not involve swelling of the soft tissues and would not cross the suture lines. This term is typically used to describe changes in the shape of the skull bones rather than soft tissue swelling.

C) Cephalhematoma present:
A cephalhematoma is a collection of blood between the newborn's skull and the periosteum (the membrane covering the bones). Unlike caput succedaneum, a cephalhematoma does not cross the suture lines because the blood is confined to the area overlying the affected bone. Cephalhematomas are typically the result of trauma during delivery, such as forceps or vacuum extraction. The swelling in a cephalhematoma is firmer and does not appear as soft or fluid-filled as caput succedaneum.

D) Fontanels soft and flat:
The fontanels are the soft spots on the baby’s head where the skull bones have not yet fused. The anterior fontanel is usually the most prominent, and the posterior fontanel is much smaller. While fontanels should be soft and flat in the early stages, this option doesn't describe the swelling or soft tissue findings as described in the question. The soft, fluid-filled swelling over the head would be more indicative of caput succedaneum rather than a normal fontanel finding.