Pregnancy

triggers synthesis and secretion of milk (made in anterior pituitary

Responsible for let-down reflex; triggered by neonatal suckling at breast or stimulation from breast pump/manual stimulation

swelling of breasts due to stasis of milk. C/O painful, tender, full breasts. Use ice packs to alleviate Sx. Prevention—regular nursing schedule. If not BF, then no nipple stimulation best.

3 days

• 1.Increased cramping during feeds due to Oxytocin release
• 2. Wear supportive bra
• 3. Ice packs to reduce discomfort
• 4. Allow nipples to air dry before putting on bra
• 5. Shower daily but do not ‘scrub’ breasts/nipples
• 6. Teach signs of good latch

• ¢ keep baby hydrated and nourished
• ¢Prevent engorgement
• ¢ lower risk of mastitis

• Postpartum Assessment
• Breast
• Uterus
• Bowel
• Bladder
• Lochia
• Episiotomy
• Homan's Sign
• Emotions
• Pain

Return of uterus to non-pregnant state following birth

Failure to return to non-pregnant state, common cause= retained placental fragments or infection

halfway between the symphysis pubis and umbillicus

2 weeks

9 days postpartum

• Breast feeding
• Early Ambulation

• prolonged labor
• difficult delivery
• overdistended uterus
• multiparity
• full bladder
• infection
• RETAINED PRODUCTS OF CONCEPTION (RPOC)- SEVERE

-more common in subsequent pregnancies due to decreased muscle tone of uterus (it has to work harder to get back to original size). After pains also increase during breastfeeding.

Lochia is discharge of blood and debris following delivery. Heaviest in morning and during/after breastfeeding. May pool in vaginal vault as pt. rests and then may gush (increase) when standing (Gravity!) Do NOT confuse with hemorrhage.

Assess pad saturation in terms of how much blood in one hour. Saturating more than one full pad in 1 hour is excessive. Documentation of lochia is by color and amount. For example: moderate, rubra.

Lochia decreases every few days (see above). Starts off rubra (bright red) then goes to serosa (reddish-brown) and then to alba (whitish). After bleeding decreases there should NOT be any increase in bleeding. Increase in bleeding or recurrence of rubra after lochia already serosa is abnormal.

If there is a foul odor, clots present (larger than a 50 cent piece) or rubra persists past 3 days—notify practitioner.

Continued lochia serosa or alba with presence of fever, pain, or abdominal tenderness. Need to treat with antibiotics.

• Bright Red bloody
• may have small cloths
• fleshy like odor
• 1-3 days post partum
• heavy to moderate throw

• pink to pink brown,
• serous,
• no clots
• 5-7 days post partum
• decrease in flow

• Cream to yellowish, may be brown
• usually no odor (unless poor hygiene)
• 1-3 weeks post partum
• Scant flow

97.9-99.7 F

• Conduction
• Convection
• Radiation
• Evaporation

heat loss by touching a cooler surface

loss of heat from air currents

loss of heat to cooler environment

heat loss when water converted to vapor

• prone to cold stress
• thin skin
• limited fat stores
• limited glucose stores
• large body surface area (can lose heat easily)
• limited ability to shiver

• Resp 30-60/min
• HR 110-160/min
• Temp 97.9-99.7

let baby sleep and recheck when awake

97.0-97.7

• Observe for signs of infection
• allow to fall off naturally
• Expose to air
• No tub baths until healed

6-12 wet diapers

• 1. immature GI sphincter and decreased stomach motility
• 2. Burp frequently, don't overfeed, elevate HOB

6 months- start on fortified cereals progressing to solid foods

within 24 hours of delivery