2. POSTPARTUM / PUERPERIUM
Refers to the six-week period after delivery of the baby
Principles:
Promote healing and involution of different parts of the body
Provide emotional support
Establish a successful lactation
Prevent postpartum complications
3. Promote healing and involution of different parts of the
body
4. Vascular changes
The 30% - 50% increase in total cardiac volume during pregnancy
will be reabsorb into the general circulation
WBC count increases to 20,000 30,000/mm3
There is extensive activation of clotting factors, which encourages
thromboembolization.
All blood values are back to prenatal levels by the 3rd and 4th
week postpartum
5. Genital Changes
Uterus
Sealing of the placenta site
Reduced to its approximate pregestational size
Assessed by measuring the fundus by fingerbreadth
In some women, causes afterpains
Nursing Management:
Never apply heat on abdomen
Give analgesics as ordered
Advise knee-chest position when perineum has healed
6. Lochia
7. Genital Changes
Characteristics of Lochia
Pattern should not reverse
It should approximate menstrual flow. However, it increases with
activity and decreases with breastfeeding
It should not have any offensive odor
It should not contain large clots
It should never be absent, regardless of the method of
delivery
8. Genital Changes
Vagina
Involution from soft and with greater diameter than normal until
its approximate pregestational state takes the entire postpartal
period
Nursing Management:
Encourage Kegel Exercise
9. Genital Changes
Perineum
Develops edema and generalized tenderness
Labia majora and minora typically remain softened
10. Sexual Activity
Maybe resumed by the 3rd or 4th week postpartum if bleeding has
stopped and episiorrhaphy has healed
11. Menstruation
If not breastfeeding, return of menstrual flow is expected within 8
weeks after delivery
If breastfeeding, menstrual return is expected in 3-4 months. In
some women, no menstruation occurs during the entire lactation
period.
12. Urinary Changes
There is marked diuresis within 12 hours postpartum
Common complaints are frequent urination in small amounts and
difficulty voiding
Nursing management:
Initiate voiding
If measures fail, catheterization as ordered.
13. Gastrointestinal Changes
There is delayed bowel evacuation postpartally which maybe due
to:
Decreased muscle tone
Lack of food and enema during labor
Dehydration
Perineal tenderness
Almost immediately, the woman feels hungry and thirsty. She can eat
unless she has the after effects of general anesthesia.
14. Vital Signs
Temperature may increase
Bradycardia is common for the 6-8 days postpartum
Orthostatic hypotension and dizziness is common
15. Weight
There is an immediate weight loss of 10-12 pounds
16. Provide emotional support
17. The Psychological Phases during the Postpartum
Taking In Phase
Taking Hold Phase
Letting Go Phase
18. Establish a successful lactation
19. Physiology of Breastmilk Production
20. Physiology of Breastmilk Excretion
1.Crying of the baby / Thinking of the baby
2.Posterior Pituitary Gland
3.Oxytocin
4.Let-down reflex
21. Advantages of Breastfeeding
For the mother:
Economical in terms of time, money, and effort
More rapid involution
Less incidence of cancer of the breast
For the baby:
Closer mother-infant relationship
Contains antibodies
Fewer incidence of GI diseases
Always available at the right temperature
22. Health Teachings
Hygiene:
Wash breast daily
Soap or alcohol should never be used
Wash hands before and after feeding
Insert clean OS squares or piece of cloth in the brassiere to
absorb moisture
23. Health Teachings
Method:
Stimulate the baby to open the mouth by means of rooting
reflex
Infant should grasp not only the nipple but also the areola
Infant should be introduced to breast gradually
Infant should be placed first on the breast he fed last in the
previous feeding
Feed by demand
Advise the mother how to relax during feedings
24. Associated Problems and Management
Engorgement: tension of the breast during 3rd to 4th days. It fades
after the infant begins sucking
Advise use of firm-fitting brassiere for good support
Cold compress / warm compress depending if the mother will
breastfeed or not
25. Associated Problems and Management
Sore Nipples
Expose nipple to air
If normal air-drying is not effective, exposure to a 20-watt bulb
placed 12-18inches away
26. Associated Problems and Management
Mastitis
Antibiotics as ordered
Ice compress
Proper breast support
Discontinue breastfeeding in affected breast
27. THE NEONATE-The first 28 days after delivery
28. Principles of Newborn Care
Establish and maintain a patent airway
Maintain appropriate body temperature
Immediate assessment of the newborn
Proper identification of the newborn
Nursery care
29. Establish and maintain a patent airway
30. Establish and maintain a patent airway
Never stimulate crying unless secretions have been drained
out
31. Position the head lower than the rest of the body except if
there are signs of increased ICP 32. Suction the baby properly 33.
Turn the head to one side 34. Suction gently but quickly 35.
Suction the mouth first before the nose 36. Test the patency of
airway
