POSTPARTUM CARE o Production of milk for lactation,
restoration of the normal menstrual
Postnatal/postpartum care is done immediately
cycle, and beginning of a parenting role
after birth. Postnatal period is a very special time
o Slower involution continues over the
where women undergo the transition into
next several weeks until pre-pregnant
motherhood.
size is attained
POSTPARTUM PERIOD
THEORY OF INVOLUTION
Period beginning immediately after birth
Involution is the process after delivery wherein the
and extending for about six weeks
uterus gradually decreases in size and descends into
The WHO describes the postnatal period as
its pre-pregnancy position in the pelvis.
the most critical yet most neglected phase in
the lives of mothers and babies, and most It normally begins immediately after delivery, when
deaths occur during this period the firmly contracted uterus lies midway between the
Time after birth in which the mother’s body, umbilicus and symphysis pubis.
including hormone levels and uterus size
return to the non-pregnant state Assessing the uterine fundus:
Also called puerperium from the Latin
The uterus is best evaluated with the patient in a
words puer meaning “child” and parere
supine position and with an empty bladder
meaning “to bring forth”
Nurse should support the lower uterine segment
Last from birth until approximately 6 weeks
just above the symphysis pubis with the non-
after delivery
dominant hand and palpate the uterine fundus for
Time of healing and rejuvenation as the
degree of involution
mother’s body returns to pre-pregnancy state
Fundal descent is measured in relationship to the
ASSESSMENT OF THE MOTHER umbilicus in fingerbreadths or centimeters
First 24 hours after birth: BUBBLE-HE (MATERNAL ASSESSMENT)
Regular assessment of vaginal bleeding, B – breast size, shape, and engorgement
uterine contraction, fundal height, U – uterus: firm or boggy?
temperature, and heart rate routinely during B – bladder: tender or distended
the first 24 hours starting from the first B – bowel movement
hours after birth L – lochia: amount, odor, color, clots
BP should be measured shortly after birth, if E – episiotomy location, stitches, edema,
normal the second BP measurement should redness
be taken within 6 hours H – Homan’s sign: positive?
Urine void should be documented within 6 E – emotional status and bonding
hours
BREASTS
Physiologic changes have two types:
Before milk production begins, the beasts secrete
Retrogressive changes – involve returning colostrum, a thin, yellowish fluid that helps maintain
the body to its pre-pregnancy state; the blood glucose level in the breastfeeding infant.
retrogressive reproductive system changes
Nipple stimulation by the infant causes the release
include:
of the hormone oxytocin from the posterior pituitary
o Shrinkage and descent of the uterus into
gland, which triggers the release of the hormone
its pre-pregnancy position in the pelvis prolactin from the anterior pituitary.
o Sloughing of the uterine lining and
development of lochia Prolactin initiates milk production, and the breasts
o Contraction of cervix and vagina become full or engorged, as well as warm and tender,
o Recovery of vaginal and pelvic floor between postpartum days 3 and 4.
muscle tone
Benefits of breastmilk/breastfeeding:
Progressive changes
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
Provides all the energy and essential nutrients Breastfeed frequently
from birth up to 6 months of life Hand express to relieve fullness
Colostrum, the first few drops of breast milk, Apply cold compress to relieve fullness
contains antibodies that protect babies against Gentle massage
infectious and chronic diseases, such as Be sure the baby latch well
diarrhea and pneumonia Wash with warm water and keep dry
Benefits for the mother: UTERUS
Burns extra calories and helps lose pregnancy Uterine involution
weight faster
Releases oxytocin that helps the uterus to Immediately after the delivery of the
return to its pre-pregnancy size and may placenta, the uterus begins to return to its
reduce uterine bleeding after birth non-pregnant size
If the baby does not adequately remove the milk from
the breasts, it may lead to breast engorgement. It
begins at the 2nd and 3rd postpartum day.
1 cm/fingerbreadth above the umbilicus for
the first 12 hours
Then descends by one fingerbreadth each
succeeding day
Symptoms:
Pain
Feeling of tenderness
Heaviness in both breasts
Generalized malaise
Transient rise of temperature
Painful breastfeeding
Sore nipples and breasts:
Normal in the first few days of breastfeeding
If it continues beyond a few days, it could
mean that the baby isn’t latching correctly
BLADDER FUNCTION
Many women experience some degree of
urinary incontinence which is the
involuntary loss of urine
Pressure from the baby’s exit may have
traumatized the bladder or anesthesia may
How have decreased its sensitivity
to prevent engorgement: BOWEL FUNCTION
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
Constipation may be caused by several things. If the FOR
patient received any pain-relieving drugs in the RUBRA Dark red 3-4 days
hospital, this could slow down the bowels. SEROSA Pinkish 4-10 days
brown
Constipation may be due to: ALBA Whitish 10-28 days
yellow
Lack of fluid and food intake during labor
Pain in the perineal area resulting from an
episiotomy, lacerations, or hemorrhoids Assessment of vaginal loss (what to ask):
Fear that they will rip their stitches should
they have a bowel movement Amount of blood loss
Color
How to deal with constipation: Presence of clots
Describe vaginal loss in sanitary pad/frequent
Eat high-fiber food to stimulate bowel
changing of pad
activity and drink plenty of water
Can also relieve hemorrhoids as well as OTC Vagina
creams or sitting in a sitz bath
Drinking water helps ease problems with Vaginal walls are smooth after delivery and
urinating after birth the vaginal folds, known as rugae, do not
Kegel exercises can strengthen pelvic return until approximately 4 weeks
muscles postpartum
Usually appears edematous and may have
Hemorrhoids small lacerations incurred during the delivery
Encourage Kegel exercise to strengthen and
Painful swelling of a vein in the rectum
tone the vagina rapidly
Strain and pushing during delivery
Can cause pain and bleeding after bowel Return of ovulation
movement
10 weeks postpartum if non-nursing
17 weeks postpartum if breastfeeding
Discuss family planning
o Wait until bleeding stops and have seen
provider for 6-week follow-up
o Discuss with provider at 6-week check-
up
EPISIOTOMY
Surgical incision through the perineum made
to enlarge the vagina and assist childbirth
The incision can be midline or at an angle
from the posterior end of the vulva,
LOCHIA performed under local anesthetic
Performed during second stage of labor to
Is the shedding endometrium quickly enlarge the opening for the baby to
After delivery, the endometrial surface of the pass through
uterus is shed via the vagina
Vaginal discharge after giving birth, The new approach:
containing blood, mucus, and uterine tissue Routine episiotomies are no longer
Typically continues for four to six weeks recommended
after childbirth Still, the procedure is sometimes needed
Occurs in three successive stages Health care provider might recommend an
COLOR LASTS episiotomy if your baby needs to be quickly
delivered
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
Reasons for episiotomy Use pain relievers, such as ibuprofen
Medicated creams
Fetal distress Local anesthetic sprays
Maternal exhaustion
Prolonged second stage of labor Take a warm, clean bath (wait at least 24 hours after
Breech presentation giving birth). Apply ice packs immediately after
o Episiotomy may provide additional room birth.
for maneuvering and placement of
Healing from an episiotomy:
forceps to aid in delivery of the baby’s
head Any stitches used to repair the episiotomy are
Delivery of a large baby usually absorbed on their own
o Shoulder dystocia is a problem that Take prescription medications or use an OTC
can occur when delivering large babies pain reliver or stool softener
o Refers to the entrapment of the baby’s
shoulders within the birth canal Episiotomy (perineal):
Wash hands before and after pad change
Ice pack after 1st 24 hours
Change pads frequently
Wipe front to back
Wash with soap and water daily
Tub/sitz bath
Stitches dissolve in about 10 days
Healing generally takes 4-6 weeks
Do not wipe area with toilet paper as it can
cause irritation to the stitched area
Types of episiotomy:
Perineal lacerations
Midline (median) incision:
o Done vertically These are vaginal tears during childbirth.
o Easier to repair, but it has a higher risk
Occur when the baby’s head is coming
of extending into the anal area
through the vaginal opening and it is either:
Mediolateral incision:
o Too large for the vagina to stretch around
o Offers the best protection from an
o Or it is a normal size but the vagina
extended tear affecting the anal area,
but is often more painful and more doesn’t stretch easily
difficult to repair Degree of lacerations of the perineum:
Evaluation of episiotomy healing: First degree lacerations extend through the
Redness skin and superficial layers of the perineum
Edema Second degree lacerations extend through the
Ecchymosis perineal muscles
Discharge, drainage Third degree lacerations extend through the
Approximation anal sphincter muscles
Fourth degree lacerations extend through the
During the first 12 hours after delivery, an ice pack anterior rectal wall and can be damaging to
may be helpful in preventing both pain and swelling the perineum
of the site of the episiotomy. The incision should be
kept clean and dry to avoid infection.
Episiotomy care and healing
To reduce the pain of the incision, one can:
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
HOMAN’S SIGN Feeling overwhelmed
Crying
This is also called dorsiflexion test which is a Reduced concentration
physical examination procedure that is used to test Appetite problems
for Deep Vein Thrombosis (DVT) Trouble sleeping
It is a blood clot that develops in the leg, What to do:
thigh, or pelvis
The enlarged uterus during pregnancy may Get as much rest as possible
also increase the risk because it puts the veins Accept help from family and friends
of the lower body under additional pressure Connect with other new mothers
to return blood to the heart Create time to take care of the self
Avoid alcohol and recreational drugs, which
can make mood swings worse
Postpartum depression
It is the type of depression that a mother may
experience after having a baby. It can start anytime
during the baby’s first year, but it’s most common to
start to feel the effects during the first 3 weeks after
childbirth. One may feel sad, hopeless, and guilty
because they may not feel the want to bond with or
care for the baby.
Signs and symptoms are more intense and last longer,
EMOTIONS and may eventually interfere with the ability to care
Baby blues vs. postpartum depression for the baby and handle other tasks. Symptoms
usually develop within the first few weeks after
It’s normal to have the baby blues during the giving birth, but may begin earlier during pregnancy
postpartum period. This typically happens a few days or later up to a year after birth.
after giving birth and can last for up to two weeks.
Withdraw from their family
Baby blues Have no interest in their baby
Have thoughts of hurting their baby
Baby blues are feelings of sadness a woman may
Depressed mood
have in the first few days after having a baby. Baby
Excessive crying
blues are also called postpartum blues. About 4 in 5
Difficult bonding with the baby
new moms (80%) have baby blues. They usually go
Withdrawing from family and friends
away on their own without the need for treatment.
Loss of appetite
Excited and happy to bring baby home Inability to sleep (insomnia) or sleeping too
Next minute though, the mother is sad much
It can be confusing, especially to new Reduced interest and pleasure in activities
mothers they used to enjoy
70-80% struggle with feeling sad the first few Intense irritability and anger
weeks after having a baby Hopelessness
Caused by hormone changes and is nothing to Feelings of worthlessness, shame, guilt, or
be ashamed of inadequacy
Severe anxiety and panic attacks
Symptoms: Recurrent thoughts of death or suicide
Mood swings Causes:
Anxiety
Sadness Physical changes
Irritability
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
After childbirth, a dramatic drop in hormones Try to get adequate rest
in the body may contribute to postpartum Eat healthy food and avoid alcohol
depression. Other hormones produced by the o Set realistic expectations
thyroid gland may also drop sharply which Don’t pressure yourself to do
can leave one feeling tired, sluggish, and everything
depressed. Do what you can and leave the rest
o Make time for yourself
Take some time for the self and get
out of the house
Do something one enjoys, such as a
hobby or some form of entertainment
Schedule some time alone with
partner or friends
o Avoid isolation
Talk with partner, family, and friends
about how one is feeling
Ask other mothers about their
experiences
Risk factors:
o Ask for help
History of depression, either during One may also benefit from asking for
pregnancy or at other times help with parenting skills that can
Experienced stressful events during the past include caregiving techniques to
year, such as pregnancy complications improve your baby’s sleep and soothe
Illness or job loss fussing and crying
Baby has health problems or other special o Getting enough rest
needs Sleep when the baby is asleep
Have difficulty breastfeeding Keep bed near the baby’s crib to
Having problems in relationship with spouse make night feedings easier
or significant other Allow someone else to feed the baby
Weak support system with a bottle while the mother sleeps
Financial problems o Eat healthy meals
Unplanned or unwanted pregnancy Maintain healthy diet to promote
healing
Increase intake of whole grains,
Treatment: vegetables, fruits, and protein
Increase fluid intake especially when
Postpartum depression is often treated with breastfeeding
psychotherapy, also called talk therapy or mental o Exercise
health counselling, medication, or both. Activity should not be strenuous
Psychotherapy – through therapy the mother Try taking a walk near the house
can find better ways to cope with their o Vaginal care
feelings, solve problems, set realistic goals, Vaginal soreness due to a tear during
and respond to situations in a positive way; delivery
sometimes family or relationship therapy also Urination problems like pain or
helps frequent urge to urinate
Antidepressants Discharges, including small blood
Lifestyle and home remedies clots
o Make healthy lifestyle choices o Schedule a check-up
Include physical activity such as a Schedule check-up about 6 weeks
walk with the baby and other forms after delivery to discuss symptoms
of exercise in the daily routine and receive proper treatment
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
Abstain from sexual intercourse for 4 Any emotional and physical changes
to 6 weeks after delivery so that the one experiences after birth will
vagina has proper time to heal slowly improve
o Adjusting to motherhood Do not hesitate to talk to the doctor
Most new mothers don’t return to about any concerns, whether it’s
work for at least the first 6 weeks related to depression, the baby, or the
after birth healing process
Allows time to adapt and develop a
new normal
Since a baby has to be fed and
changed often, sleepless nights may
be experienced
It can be frustrating and tiresome
o Seek help
Accept help from family and friends
during the postpartum period, as well
as after this period
Family can prepare meals, run
errands, or help care for other
children in the home
o Functioning as a new family unit
During postpartum period, partner may
also spend less quality time together,
which can be troublesome
This is an overwhelming and stressful
period, but there are ways to manage
o Coping with body change
Once the doctor says it’s okay to
exercise, begin with moderate activity
a few minutes a day and gradually
increase the length and intensity of
the workouts
Go for a walk, swim, or join an
aerobics class
Every new mother loses weight at a
different pace, so don’t compare
weight loss efforts to others
Breastfeeding can help return to pre-
pregnancy weight faster because it
increases calorie burn
o Vaginal discharge
Typical for two to four weeks after
giving birth
This how the body eliminates blood
and tissue from the uterus
Wear sanitary napkins until discharge
stops
o Outlook
Giving birth can change the family
unit and routine, but one can
eventually adjust
This study source was downloaded by 100000833392052 from CourseHero.com on 08-18-2022 11:49:54 GMT -05:00
https://www.coursehero.com/file/94988215/MCHN-PART-5docx/
Powered by TCPDF (www.tcpdf.org)
