Postpartum

First six weeks after birth of infant

Puerperium

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

• Fatigue
• 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

6 weeks

Neurohormonal reflex that causes milk to be expressed

Responsible for milk production.

Responsible for milk “let down” or ejection from breast.

Breastfeeding

3 months

Yellowish fluid rich in antibodies and high in protein first two or three days after birth.

Three or four

Distention, swelling, and tenderness

One week

Wear a well fitting bra continuously for several days.

Eat and drink

500 more calories

• Decreased peristalsis
• Diarrhea
• Lack of food during labor
• Dehydration
• Perineal trauma
• Hemorrhoids
• Anticipation of discomfort
• Pain medications

500 ml

1000ml

Postpartum hemorrhage

Thrombus formation.

Thrombus formation

• Over distention
• Emptying

Up and to the side

When uterus remains flaccid and the client passed large clots although the fundus has been massaged every 15 minutes

Every 15 minutes.

Helps keep it tight and slows bleeding.

Massage the fundus and have someone call the MD

Increase

6 weeks

• Melanocyte- stimulating hormone declines
• Hyperpigmentation lightens*
• Most of the skins elasticity returns
• Striae (stretch marks) May still be visible
• Fine hair usually disappears

• Fatigue
• After pains
• Muscles ache
• Episiotomy
• Abd incision pain
• Breast enforcement

Pregnancy- induced hypertension

• 13
• Infant, placenta, amniotic fluids, and blood loss.

8-9

Resulting from dieresis, diaphoresis, and involution.

6mo

• Occurs within the first 24 hrs after birth.
• Mom needs food, drink, and sleep.

• Mother becomes more independent and takes an interest and responsibility for her own care.
• Focus shifts to the care of the infant

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

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

May be harder to bond with

• 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

• BUBBLE
• Breast
• Uterus
• Bladder
• Bowels
• Lochia
• Episiotomy, lacerations, and c section

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****

• 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 👌🏻

• Massage the fundus or encourage breast feeding
• If those don’t work md may prescribe pitocin

Fullness of bladder and distention

24

Hemorrhoids

• Vaginal discharge after birth
• Changes from rubra (red) to serosa (pink) to alba (white)

Color, amount, Pedro and presence of clots.

Rubra with small pieces of mucus

• Decreases
• Color is pink or brown

Discharge becomes yellowish white (alba)

Common

• Mom in sims position
• Redness=inflammation
• Ecchymosis= bruising
• Edema= swelling
• Possible discharge
• Approximation of suture line
• Pain of labia

• 100.4
• 24 hrs

Infection

• 50-70
• First hour

Elevation may indicate pain, anxiety, or HEMORRHAGE

PIH

Excessive bleeding

• Redness, heat, edema, and tenderness
• Homans signs: pain with dorsal flexion of foot.

• The way mothers hold, examine, and speak to infant.
• Important signs: cradling, gazing at infant, speaking pleasantly

Observing feedings, dispersing, bathing and consoling skills

• 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******

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.

• 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.

Prevents uterus from contracting effectively and bleeding continues.

May occur in the perineum, vagina, cervix, or around urethral meatus.

Bleeding into tissue with no external laceration.

1-2 weeks after birth

Tachycardia from hypovolemic shock.

Low playlets, Hx of bleeding, Hx of alcohol abuse, herbal and homeopathic remedies, ASA or NSAIDS, obesity or poor nutrition.

• Oxytocin/pitocin
• 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

• 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

35+, c section, prolonged time in stirrups, obesity, smoking, Hx of varicosities or venous thromboses.

• Frequent early ambulation to increase venous return
• Avoid prolonged standing or sitting
• Do not cross legs

• 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.

Missed abortions, abruptio placentae, amniotic fluid embolism, sever preeclampsia, hemorrhage and a dead fetus.