Postpartum
Postpartum PeriodPosTPARTAL PERIODPuerperium-puer means child,
parere to bring forthThis happens on the 1st 6 weeks after child
birthWHAT HAPPENS TO THE MOTHERS BODY DURING THIS TIME?* Involution
of the Uterus- the return of the uterus to its pre-pregnant state*
Production of milk for lactation,*restoration of Menstrual
Cycle*Parenting Role beginsPhases of puerperiumTaking In Phase2 to
3 days, a woman is largely passiveWoman usually wants to talk about
her pregnancy, especially about her labor.A woman in this phase is
DEPENDENT. This dependenceresults partly from her physical
discomfort becauseof afterpains or hemorrhoids; partly from her
uncertainty incaring for her newborn; and partly from the extreme
exhaustionthat follows childbirthMAIN NURSING RESPONSIBILITY:Allow
the mother to verbalize feelings.Help the mother interpret events
of delivery to make them more meaningful and to clarify
misconceptions.Phases of puerperiumTaking Hold PhaseOccurs during
the 1-3 days after deliveryMarked by a period of being dependent
and passive behavior.Mother is during this ttime is talkative about
her labor and delivery.
PRIMARY NEED OF MOTHER: (her own) Food and Sleep
MAIN NURSING RESPONSIBILITY:The best time to do health teaching
to the mother. Identify areas to focus health teaching.Provide
brief demonstration on how to care for her baby and allow her to
care for her child--- under watchful supervision.Phases of
puerperiumC. Letting Go Phase* This process requires some grief
work and readjustment of relationships, similar to what occurred
during pregnancy.Woman defines her role as a Mother to her
newbornShe gives up the fantasized image of her child and accepts
the real one.She gives up her role of being childless or the mother
of only one or two children.DEVELOPMENT OF PARENTal love and
positive family relationshipEn Face Position eye-to-eye
contactExplore newborn with fingertipsHand and palmar contactWhole
arms enfolds whole baby close to the body
*CLAIMING or BONDINGThe Claiming Process includes the
identification of the babys specific features, relating them to
other family members.Those long toes are just like his Dads.The
babys facial features are just like her sisters.Rooming INThe
infant stays in the room with the mother, rather than in the
nursery.This is the best time to initiate bonding with the mother
and other family members.Mother can be better acquainted with her
child and begin to feel more confident in her ability to care.
Nursing Responsibility: During this time, provide assistance to
the mother in performing activities to her child, such as proper
latch on, proper way to carry the child, how to burp the child,
etc.Maternal concerns and feelingsAbandonment
DisappointmentPostPartal Blues50% of women experience some feeling
of overwhelming sadness for which they cannot account Hormonal
changes- decreased progesterone and estrogen Response to dependence
and low self esteem caused by exhaustion, being away from home,
physical discomfort and tension Fearfulness, feeling of inadequacy,
mood ability, anorexia and sleep disturbance Assurance and
support
Physiologic changes of the postpartal period
Involution Reproductive organs return to
Uterus 2 process 1.The area where the placenta is sealed off
Accomplished by rapid contraction of the uterus after the delivery
of the placenta Muscle fibers become shorter controlling the
bleeding by compressing and sealing off blood vessels
Physiologic changes of the postpartal periodUTERUS2. The organ
is reduced to its pregestational size through Autolytic process Few
cells of the uterine wall are broken down into their protein
component which is then absorbed in the blood stream and excreted
in the urine. Contraction
-Immediately after birth 1000g -At the end of 1st wk- 500g -6wks
50g
Physiologic changes of the postpartal periodUTERUS
After placental delivery the uterus may be palpated through the
abdominal wall halfway bet the umbilicus and the symphysis
pubis
-1hr after- level of umbilicus -Decrease 1 fingerbreath
NURSING RESPONSIBILITY*ASSESS the uterus: *Placement and
location should be level with the umbilicus after delivery. The
uterus then should decrease 1 FB / day. Should also be midline and
the size of a grapefruit *Uterine Toneshould be firm. Assess by
supporting lower portion with one hand and palpate fundus with
other. If found boggy, then massage. Do not overmassage. * Lochia:
Color, and odor Rubra Color: RedDuration: 1-3 daysComposition:
Blood, Decidua Fragments, MucusSerosa- Color: PinkDuration: 3-10
daysComposition: Blood, Mucus, LeukocytesAlba- Color:
WhiteDuration: 10-14 daysComposition: Largely mucus
Characteristics of Lochia Should not be excessive in amount
Should not have an offensive odor Should not contain large pieces
of tissue or blood clots Should not be absent during the first 3
weeks Should proceed from rubra -- serosa -- alba
Physiologic changes of the postpartal periodCervix After birth-
soft and malleable, internal and external os is open Pre-pregnant
appearance is a dimpled area in the center -- post-pregnancy
appears as a jagged slit.
Vagina Check if vaginal area is edematous and bruised. Rugae
begin to appear when ovarian function returns. - Teach the mom to
do Kegels exercises.
Physiologic changes of the postpartal periodPerineum: Check for
tears, lacerations and intactness of the episotomy site.*Mother may
perform sitz bath under nurses supervision 3-4x a day.
BreastsAssess for presence of nodules and lumps. Nipples for
inversion, bleeding, pain, blisters and other abnormalities.Teach
mother how and when to assess her own breast using the Breast Self
Exam Procedure and principles.Individualize teaching for
breastfeeding and non-breastfeeding mothers.
Process of Lactation
Sucking of infant stimulates the nerves beneath skin of the
areola to transmit messages to the hypothalamus
Hypothalamus sends messages to the pituitaryAnterior Pituitary
Gland receives message and produces PROLACTIN needed for gland milk
production.Oxytocin is then released by the Posterior Pituitary
Gland for the LET DOWN Reflex, to stimulate contraction of cells
around the mammary gland. Oxytocin also causes contraction of the
uterus.Nursing responsibility:educate mother on properbreastfeeding
careUse warm water in taking a bath or washing nipples, no soap on
nipples. Wear supportive bra.Avoid tight fitting bra or
binder.Breastfeeding tips:*Teach the mother how to Latch Onthe
infant properly. The infant should fully get the nipple and the
areola in the mouth.*Teach various positions to hold the baby
(football hold, side lying position, etc.)*Feed the baby at least
every 2 hours or PRN.* Relax to allow let down
Elimination Changes Gastro-Urinary System Mild Proteinuria is
Normal.Diuresis is common loss of fluid of pregnancy. 2000-3000ml
of excess fluid accumulates in the body during
pregnancy.Hemorrhoids or distended rectal veins may have been
pushed out of the rectum, because of the effort of pelvic stage
pushing.NSG responsibility:Assess and measure first two voidings
post delivery.Important to attempt to void every 3-4hrs. If patient
is unable to void, assess if there is a need for
catheterization.PATIENT TEACHING:Increase Fluid intake and
activity, eat lots of fibrous foods. Stool Softeners, Anesthetic
sprays,and Tucks**ENEMA OR SUPPOSITORIES should not be administered
to patients with 3rd to 4th degree of lacerationEffects of
retrogressive changesExhaustion: because of the labor process. NSG
RESPONSIBILITY: Provide adequate rest and sleep period to the
mother.b. Weight Loss: due to rapid diuresis during the 2-5 days
post partum. Lochial flow also causes additional weight loss.
However, additional weight loss is most dependent to the amount of
pregnancy weight gain and the active measures the woman performs to
lose weight. NSG RESPONSIBILITY: Assess womans health and
nutritional status to prevent obesity or being underweight/
nourished.c. Vital Sign Changes: reflect the internal adjustments
that occur as a womans body returns to its pre-pregnant state.
Temperature: slightly increased during the 1st 24 hrs
post-partumNSG RESPONSIBILITY: Assess womans vital signs and report
abnormalities as needed for early diagnosis of complication of
infection. Encourage mother to increase fluid intake.Pulse: slighty
lower or slower than normal (60-70 bpm) due to increased stroke
volume of the heart.NSG RESPONSIBILITY: Evaluate Pulse rate
conscientiously, a rapid thready pulse could be a sign of
hemorrhage.Blood pressure: decrease in BP postpartum may denote
Bleeding. Elevated BP post partum (above 140/90mmhg) may indicate a
development of postpartal PIH, an unusual but serious complication
of the puerperium.NSG RESPONSIBILITY: Evaluate Blood Pressure at an
interval directed by the AP. Assess effects of oxytocin
administration to the post partal woman, as this may also cause BP
elevation and possibly a CV accident. In general, the following are
the nursesresponsibility in caring for a Postpartum mother:Perform
thorough assessment of the post-partal mother, to include the
uterine location, tone and lochial discharges.Observe for signs of
complication such as elevated BP, bleeding, rapid thready pulse, an
elevated temperature, edema, pallor, and inflammation of
breast.Provide adequate rest and sleep to the woman to replenish
lost energy during the labor and delivery process.Encourage
increased intake of nutritious foods, foods high in roughage
content and water to remain well nourished, good hydration and aid
in the comfortable elimination of human waste.Provide measures to
relieve pain and discomfort of the mother, as directed by the AP,
if needed. (medications, sitz bath, hot or cold theraphy, massage,
and others.)Perform thorough assessment of the post-partal mother,
to include the uterine location, tone and lochial
discharges.Observe for signs of complication such as elevated BP,
bleeding, rapid thready pulse, an elevated temperature, edema,
pallor, and inflammation of breast.Provide adequate rest and sleep
to the woman to replenish lost energy during the labor and delivery
process.Encourage increased intake of nutritious foods, foods high
in roughage content and water to remain well nourished, good
hydration and aid in the comfortable elimination of human
waste.Provide measures to relieve pain and discomfort of the
mother, as directed by the AP, if needed. (medications, sitz bath,
hot or cold theraphy, massage, and others.)Observe aseptic measures
at all times, especially in handling blood products, performing
wound care, med administration and breastfeeding.Promote
independence by letting the woman perform self care procedures by
herself as soon as she is able to.Educate the mother on various
methods to promote:Uterine involutionBreast care and breast
feedingRelaxation and pain alleviation Muscle strengthening
exercisesMaternal and infant well-being
PostPARTAL DISCHARGE INSTRUCTIONS
Thats all folks!Thank you for listening!
