First six weeks after birth of infant
What’s the fourth trimester of pregnancy
Newborn up till 28 day
- Rapid process of attachment for the parent and child.
- Takes place during the first 30-60 minutes after birth.
Long term process that establishes enduring bond between parent and child.
Parents identified likenesses and differences
Parents interest and preoccupation in the new born
Factors affecting adaptation of the parents
- Previous experience with newborn
- Expectations of newborn
- Knowledge of and confidence in providing care
- Temperament of newborn *
- Temperament of parents
- Age of parents
- Support systems
Return of uterus to prepregnancy size and condition
Vaginal discharge after child birth
It takes _____ for the vagina to regain pre-pregnancy contour
Let down reflex
Neurohormonal reflex that causes milk to be expressed
Responsible for milk production.
Responsible for milk “let down” or ejection from breast.
____ is not a reliable method of birth control
Most non breast feeding mothers will resume me striating within _____
Yellowish fluid rich in antibodies and high in protein first two or three days after birth.
Engorgement occurs by day _____
Three or four
Vasocongestion of breast tissue during milk production causes
Distention, swelling, and tenderness
Lactation ceases within ______ if breast feeding stopped or never begun
To suppress lactation and promote comfort, mothers should
Wear a well fitting bra continuously for several days.
Mothers can ____ following recovery from analgesia
Eat and drink
Breast feeding mothers should consume _____ than usual pre preg diet
500 more calories
Causes difficulty with BM
- Decreased peristalsis
- Lack of food during labor
- Perineal trauma
- Anticipation of discomfort
- Pain medications
Blood loss for vagina birth is ___
Blood loss for c section is ____
Increased levels of clotting factors and fibers protect against ______ but can lead to ____
Moms with varicose veins, c sections, or Hx of thrombophlebitis are at increased risk for
Mothers may have problems with _____ and ______ of bladder
Full bladder displaces the uterus
Up and to the side
When uterus remains flaccid and the client passed large clots although the fundus has been massaged every 15 minutes
How often should the nurse massage the fundus after birth ?
Every 15 minutes.
Helps keep it tight and slows bleeding.
What to do with uterine atony
Massage the fundus and have someone call the MD
May have permanent ____ in shoe size
Takes ___ for abdominal muscles to return to pre-pregnant state
In relation to the skin, changes that occur after pregnancy
- Melanocyte- stimulating hormone declines
- Hyperpigmentation lightens*
- Most of the skins elasticity returns
- Striae (stretch marks) May still be visible
- Fine hair usually disappears
Maternal discomfort can be caused from
- After pains
- Muscles ache
- Abd incision pain
- Breast enforcement
Mothers with headaches should be assessed for
Pregnancy- induced hypertension
Immediately after giving birth mothers will lose ____lbs
- Infant, placenta, amniotic fluids, and blood loss.
Within six weeks of giving birth mothers will lose ____lbs
Resulting from dieresis, diaphoresis, and involution.
It takes _____ for moms to return to prepregnancy weight
Taking in phase
- Occurs within the first 24 hrs after birth.
- Mom needs food, drink, and sleep.
Taking hold phase
- Mother becomes more independent and takes an interest and responsibility for her own care.
- Focus shifts to the care of the infant
Letting go phase
Move past the role of expecting and moves forward as a family unit.
Emotional lability and crying for no apparent reason
Can last 2 weeks
Unplanned C section
Taking in phase may last longer
Help mom understand the birth and incorporate the experience into her reality
- Mild, moderate, or severe
- Cares for infant but Is unable to feel the love
- Irritability, guilt, shame, unworthiness, sense of self loss.
Symptoms persists beyond first few weeks after birth.
Paranoid, grandiose or bizarre delusion, mood swings, confused thinking, grossly disorganized behavior that represent dramatic change from previous functioning.
Obsessive concerns about the infant health
Infants with problems
May be harder to bond with
Newborns and mothers health protection act of 1996
- Requires health plans to allow 48-hour stay after vaginal birth and 96 hour stay after c-section birth.
- May offer home care follow up
- Teach pt to report any fever or bright red discharge
Nursing process for a postpartum pt
- Episiotomy, lacerations, and c section
When examining the breast note
Size, shape, abnormalities and reddened areas
Palpate for softness, firmness, engorgement, warmth, tenderness
Check nipples for cracks, fissures, soreness, and inversion.
*** if mastitis is diagnosed, pt can still breast feed as long as there aren’t abscesses****
When assess uterus
- Palpate fundus
- Note size, consistency, and placement.
- Fundus should be around the umbilicus for the first 12hrs after birth.
- Should be firm and midline
- Should decrease one finger breadth per day (1cm) *****
- After pains
- Breast feeding stimulated the release of oxytocin which stimulates uterine contractions. = involution 👌🏻
If uterus is boggy, soft, and above umbilicus, nurse should
- Massage the fundus or encourage breast feeding
- If those don’t work md may prescribe pitocin
If boggy uterus with fundus above the inimical snd divisors to the side assess
Fullness of bladder and distention
I and o is kept for ____hr after birth
Inspect anus for ____ when checking episiotomy
- Vaginal discharge after birth
- Changes from rubra (red) to serosa (pink) to alba (white)
Assess______ with lochia
Color, amount, Pedro and presence of clots.
For the first three days lochia is
Rubra with small pieces of mucus
On 4th day after birth,lochia
- Color is pink or brown
After 10 days, Lochia
Discharge becomes yellowish white (alba)
It is _____ for lochia to increase with animation of increases activity
To assess episiotomy
- Mom in sims position
- Ecchymosis= bruising
- Edema= swelling
- Possible discharge
- Approximation of suture line
- Pain of labia
Temp increases to ___ for ____ after birth
After 24 hrs and elevated temp may indicate ___\ after birth
Pulse may decrease to _____ after ____
Elevation may indicate pain, anxiety, or HEMORRHAGE
Increased BP after birth may indicate
Decreased BP after birth may indicate
S/s of thrombophlebitis
- Redness, heat, edema, and tenderness
- Homans signs: pain with dorsal flexion of foot.
Bonding and attachment is
- The way mothers hold, examine, and speak to infant.
- Important signs: cradling, gazing at infant, speaking pleasantly
Assess parenting capability by
Observing feedings, dispersing, bathing and consoling skills
Assess self care by
- Showering, perineal care, checking the fundus, breast care, and rest.
- Encourage mom to bathe, toilet, and feed herself independently.
***** assist moms with first time getting out of bed after brith******
Rh Immune Globulin
Given with 72 hrs to prevent sensitization or Rh
(Neg mom, positive baby)
Recommended for all women who have not had rubella or have 1:8 titer in postpartum period.
- Should be given before discharge.
- Breast feeding allowed
- Shouldn’t get pregnant for three months.
What to assess with c sections
- Incision:redness, heat, pain, edema, and suture line approximation.
- *may produce less lochia and clots.
- Assess RR and breath sounds
- Assess effort of changing position, cough and deep breathing, incentive spirometer.
- Assess abd and bs, I AND O, pain.
- Hemorrhage is a stead food of blood.
- Uterus boggy or soft.
Retained placental fragments
Prevents uterus from contracting effectively and bleeding continues.
Laceration of the birth canal
May occur in the perineum, vagina, cervix, or around urethral meatus.
Bleeding into tissue with no external laceration.
Late hemorrhage occurs
1-2 weeks after birth
First sign of late hemorrhage
Tachycardia from hypovolemic shock.
Predisposing factors for late hemorrhage
Low playlets, Hx of bleeding, Hx of alcohol abuse, herbal and homeopathic remedies, ASA or NSAIDS, obesity or poor nutrition.
Medical management of hemorrhage
- Possible D&C or evacuation of hematoma
- Md palpates uterus to make sure it’s contracting
- Thorough exam of birth canal for laceration or hematoma
- Occurs between birth and 6 weeks postpartum
- Fever of 100.4 on two separate occasion within 24hr.
- Includes wound infection, metritis, mastitis, and UTI
Med/surg management of infection
- Removal of suture to allow drainage
- C&S to ID organism.
- Hot showers for comfort and blood flow for pts with mastitis. Still allows to breast feed until abscess ruptures
- Metritis=iv antibiotics
- Mastitis= early antibiotic therapy to prevent abscess
Risk factors for thrombophlebitis
35+, c section, prolonged time in stirrups, obesity, smoking, Hx of varicosities or venous thromboses.
How to prevent thrombophlebitis
- Frequent early ambulation to increase venous return
- Avoid prolonged standing or sitting
- Do not cross legs
Med surg management of thrombophlebitis
- Analgesics, antibiotics,
- iv heparin if DVT is present for 5-7 days followed by anticoagulant for 6 weeks or more.
- Rest, elevation of affected leg, local application of heat, TED, Doppler for affected extremity.
Disseminated intravascular coagulation
Abnormal stimulation of clotting
Causes clots then causes bleeding.
DIC may result from
Missed abortions, abruptio placentae, amniotic fluid embolism, sever preeclampsia, hemorrhage and a dead fetus.