Professional Documents
Culture Documents
POSTPARTUM CARE
Puerperium/Postpartum Period
- Refers to the six (6) weeks period after delivery of the baby
- Time of maternal changes that are both
o Retrogressive (involution of uterus and vagina)
o Progressive (production of milk for lactation, restoration of normal menstrual cycle, and
beginning parenting role)
BREASTS
UTERUS
BLADDER
BOWELS
LOCHIA
EPISIOTOMY
HOMAN’S SIGN
EMOTIONAL STATUS
1. Vital signs
• Assess q 15 min x 4; then q 30 min x2; then q 4 hrs for the first 24 hrs (if stable) then q 8
hrs
• Temp- 98-100.4 degree F (36.6-38 degree C): normal for the 1st 24 hrs due to DHN during
labor
o Increase in body temperature during the first 24 hours is not necessarily a sign of
postpartum infection.
o Bradycardia (heart rate of 50-7- bpm) is common for (24-48 hrs) and persist 6-8
days postpartum.
• Lacatation- formation of breast milk (BM); begins in a postpartal woman whether or not she
plans to breast-feed.
• Colostrum is present at the time of delivery; BM is produced by the 3rd and 4th postpartum
day; yellow sticky fluid; more protein, less sugar, less fat than mature milk.
• Engorgement_ the feeling of tension (heat or throbbing pain) in the breast as breast
distention becomes marked (fuller, larger, firmer); occurs on the 3rd -4th day
o Due to expanding veins and pressure of new breast milk contained with them
• In breast, prolactin stimulates alveolar cells to produce milk. Sucking of the newborn triggers
a release of oxytocin and contractility of the myoepithelial cells, which stimulate milk flow;
this is known as the let down reflex. The average amount of milk produced in 24 hours
increases with time:
o 1-4 weeks- 20 oz
o After 4 weeks- 30 oz
Mature milk
• Amount of supply depends on how often the mother nurse or pumps ( the more the mother
nurses, the more milk is produced)
• For those who choose not to breastfeed, lactation can be suppressed through:
o Avoid any type of nipple stimulation or heat to the breasts (such as warm/hot
showers)
o May use ice packs or cold cabbages leaves to east breast discomfort until milk
production ceases (it generally takes 5-7 days)
o Mild analgesics as prescribed
3. Uterus
• After delivery of the newborn, involution of the uterus must occur; 2 main processes:
• Few minutes after birth, fundus halfway between umbilicus and symphysis pubis
• One hour later, rise to the level of umbilicus and it remains for the next 24 hours
• Day 2- 2 finngerbreadth below and so forth until day 10, it can no longer be palpated
because it is already behind symphysis pubis
o Subinvoluted Uterus
Uterus larger than normal and vaginal bleeding with clots. Since blood clots
are good media for bacteria; it is therefore as sign of puerperal sepsis
o Afterpains/afterbirth pains
• Menstruation
Though does not guarantee that woman will not conceive because she may
ovulate well before menstruation returns
4. Bladder Elimination
• Marked dieresis to eliminate excess fluid (as much as 2000-3000ml accumulates in the body
during pregnancy)
• May complain of frequent urination in small amounts: explain that this is due to urinary
retention with overflow
• May have difficulty voiding because of abdominal pressure or trauma to the trigone of the
bladder
o Percussion: resonant
o If these measures fail, catheterization, done gently and aseptically, is the last resort
on doctor’s order. (if there is resistance to the catheter when it reaches the internal
sphincter, ask patient to breathe through the mouth while rotating the catheter
before moving it inward again.)
5. Bowel Elimination
o Dehydration
6. Lochial discharge ( during the 1st 3 weeks after delivery)- uterine discharge consisting of blood,
deciduas, WBC, mucus and some bacteria
• It should approximate menstrual flow. It increases with activity and decreases with
breastfeeding.
• Types of lochia:
o Lochia rubra
o Lochia alba
o Lochia serosa
Odorless
7. Episiotomy/Perineum
• Appears edematous and bruised after delivery caused by episiotomy (if performed) and some
degree of laceration
o 1st degree- lacerations extend through the skin and superficial layers of the
perineum
o 4th degree- through the anterior rectal wall and can be damaging to the perineum
• Prevention of lacerations:
o Massage
o Warm compress
o Perineal heat lamp or warm sitz baths twice a day- vasodilation increases blood
supply and therefore, promotes healing
o Apply ice or cold therapy to the episiotomy or laceration immediately after delivery
to decrease edema and provide anesthesia; thereafter apply moist or dry heat
therapy to promote comfort and healing
8. Homan’s sign/Legs
• Relative inactivity/prolonged time in stirrups leads to stasis of blood and promotes clotting of
blood in the lower extremities
o It is also important to note that a DVT may be present despite a negative Homan’s
sign
• Early ambulation
• The postpartum period represents a time to emotional stress for the new mother, made even
more difficult by the tremendous physiologic changes that occur
• Factors influencing successful transition to parenthood during the postpartum period include:
o Cultural influences
• Rubin (1997) describes this period as occurring in three stages: taking-in, taking-hold and
letting-go
o TAKING-IN PERIOD
Occurring 1-2 days after delivery, the new mother typically is passive and
dependent
Encourage her to talk about the birth will her integrate it into her life
experiences
o TAKING-HOLD PERIOD
Woman begins to initiate action; she prefer to get her own wash cloth and
make her own decisions
Mother focuses on regaining control over her bodily functions: bowel and
bladder function, strength and endurance
• Provide praises
o LETTING-GO PERIOD
Generally occurs after the new mother returns home. It involves a time of
family reorganization
She gives up the fantasized image of her child and accepts the real one.
ATTACHMENT
• Holding
• Kissing
• Cuddling
POSTPARTUM BLUES
• “baby blues”; normal part of postpartum experience but only for a few days
o Anticipatory guidance and individualized support from health care personnel are important to help
the parents understand
o Allow her to make as many decision as possible can help give her sense of control over her life
POSTPARTUM DEPRESSION
• A serious & debilitating depression, occurring within first 9 months after delivery, often within the initial
weeks or months
• Sadness, crying, insomnia, decreased appetite, withdrawal and sometimes suicidal ideation or the desire
to harm the infant
• Somatic symptoms: headaches, diarrhea, constipation, severe anxiety, feeling as though they are jumping
out of their skinm and/or just not feeling like themselves
• Management:
o Assessment tools:
Edinburg Postnatal Depression Scale (EPDS)
o Help patient and family to understand this condition and assist to explore spiritual aspect of care
1. Cardiovascular system
• 30-50% increase in total cardiac volume during pregnancy will be reabsorbed into the general
circulation within 5-10 minutes after placental delivery
• Blood volume decrease to non pregnant levels by fourth week after delivery
o Aid to healing
When ambulating the newly-delivered patient for the first time, the nurse
should hold on to the patient’s arm.
o Massage is contraindicated.
• All blood values are back to prenatal levels by the 3rd-4th week postpartum
• Vaginal dryness and painful intercourse (dyspareunia) may be noted during the postpartum
period due to decreased estrogen levels.
3. Integumentary system
• Mask of pregnancy (chloasma) usually disappears, while stretch marks (striae gravidarum) and
linea negra fade but generally do not disappear
4. Endocrine system
• Estrogen and progesterone level decreases as soon as the placenta is no longer present
• FSH remains low for about 12 days and begins to rise as new menstrual cycle is initiated.
Menstruation return in approximately 6-8 weeks; ovulation cam return within 4 weeks.
5. Musculoskeletal system
• Relaxin is the hormone responsible for the relaxation of the pelvic ligaments and joints during
pregnancy. After delivery, relaxin level subsides and the pelvic ligaments and joints return to their
pre pregnant state. However, the joints of the feet remain altered and many patients notice a
permanent increase in shoe size.
• Abdominal wall is weakened and the muscle tone of the abdomen is diminished after pregnancy.
Some patients have a separation between the abdominal wall muscles, called diastasis recti. This
separation can ofte be corrected with certain abdominal exercises (sit ups) performed during the
postpartum period.
6. Urinary changes
• Extensive diuresi begins to take place almost immediately after birth to rid the boyd of fluid
• Increases the daily output a postpartal woman from a 1500- 3000 ml/day during the 2nd-5th day
after birth
• Contain more nitrogen than normal (due to breakdown of protein in a portion of uterine muscle)
• Urinary retention as a result of decreased bladder tone and emptying can lead to urinary tract
infections
• Instruct the client on sitting properly to relieve pain (squeeze the buttocks together and contract
pelvic floor muscles before sitting)
• Demonstrate how to clean the perineum after each voiding and defecation (wiping form front to
back), washing the hands and applying a perineal pad from front to back
• Teach the importance of adequate fluid intake, exercise, proper diet and a regular defecation time
• Provide adequate dietary fiber and fluids to promote bowel movements; if necessary administer
stool softeners, laxatives, suppositories or enema
• Recommended exercise:
• Sexual activity
o Decreased physiologic reactions to sexual stimulation are expected for the 1st 3 months
postpartum because of hormonal changes and emotional factors.
• Postpartum check up- 4-6 weeks after birth. Woman should return to her physician for an
examination (visit is important to ensure that involution is complete and reproductive planning is
desired and may be discussed further.)
BREASTFEEDING
• Feed newborn per demand (breastfeeding or bottlefeeding) or at least every two hours and
intervals should not exceed 5 hours
• If breastfeeding
o From birth to at least 2 years and should continue as long as the mother and child wish
o Exclusive breastfeeding until 6 months of age (when solid are gradually introduced)
o Correct latching on ( to prevent nipple sores and allow baby to get enough milk)
Large part of the breast and areola need to enter the baby’s mouth
Nipple should be at the back of the baby’s throat with the baby’s tongue lying
flat in its mouth
A combined refrigerator and freezer with separate -18 degree C 3-6 months
doors
Chest or upright manual defrost deep freezer -20 degree C 6-12 months
• Oral contraceptives are contraindicated in lactating mothers because they contain estrogen and
progesterone derivatives, thereby decreasing milk supply
BREAST CARE:
• Soap or alcohol should never be used on the breast as they tend to dry and crack the nipples and
cause sore nipples
• Insert clean OS squares or piece of cloth in the brassiere to absorb moisture when there is
considerable breast discharges.
• Engorgement managemet:
o Nurse often (not going more than 3 hours without nursing and not skipping night
feedings)
o Well-fitted bra
o Warm compress/shower
3. Roll thumb and fingers forward at the same time. This rolling motion compresses and empties milk reservoirs
without injuring sensitive breast tissue.
Note the position of thumb and fingernails during the finish roll as shown in the illustration.
5. Rotate the thumb and fingers to milk other reservoirs, using both hands on each breast.
2. Sliding hands over the breast may cause painful skin burns.