Manila Central

University
College of
an
Nursing
d
POSTPARTAL
 OVERVIEW
A. ESSENTIAL CONCEPTS
B. GOALS OF POSTPARTAL CARE
C. FACTORS AFFECTING THE
POSTPARTAL EXPERIENCE
D.NURSING RESPONSIBILITIES

Postpartum period
ESSENTIAL
CONCEPT
S
Postpartum period
ESSENTIAL CONCEPTS
POSTPARTUM CARE
Refers to the medical and
nursing care given to a patient
from the time of delivery until
her body returns to near it’s
nonpregnant state

Postpartum period
 ESSENTIAL
CONCEPTS
PUERPERIUM
Is the 6-week period after delivery
Beginning w/ termination of labor
and ending w/ the return of the
reproductive organs to nonpregnant
state
A physical and psychological
adjustment to the process of
childbearing
Postpartum period
 ESSENTIAL
CONCEPTS
INVOLUTION
Progressive changes
in the uterus after
delivery
Leading to its return
to prepregnant state
and condition
Postpartum period
 ESSENTIAL
CONCEPTS
POSTPARTAL PERIOD
Sometimes referred as the
fourth stage of pregnancy

Postpartum period
 ESSENTIAL
CONCEPTS
One aspect of care that
commonly suffers w/ the trend
toward earlier discharge is
support in breast-feeding

Postpartum period
 GOALS OF
POSTPARTAL
CARE
Postpartum period
 GOALS OF
POSTPARTAL CARE
Promote normal involution and
return to the nonpregnant state

Postpartum period
 GOALS OF
POSTPARTAL CARE
Prevent or minimize postpartum
complications

Postpartum period
 GOALS OF
POSTPARTAL CARE
Promote comfort and healing of
pelvic, perianal, and perineal
tissues

Postpartum period
 GOALS OF
POSTPARTAL CARE
Assist in restoration of normal body
functions

Postpartum period
 GOALS OF
POSTPARTAL CARE
Increase understanding of
physiologic and psychological
changes

Postpartum period
 GOALS OF
POSTPARTAL CARE
Facilitate newborn care and self-
care by the new mother

Postpartum period
 GOALS OF
POSTPARTAL CARE
Promote newborn’s successful
integration into the family unit

Postpartum period
 GOALS OF
POSTPARTAL CARE
Support parenting skills and parent-
infant attachment

Postpartum period
 GOALS OF
POSTPARTAL CARE
Provide effective discharge
planning, including appropriate
referral for homes care follow-up

Postpartum period
Factors affecting the
postpartal
experience
Postpartum period
Factors affecting the
postpartal experience
Nature of labor and delivery and
birth outcome

Postpartum period
Factors affecting the
postpartal experience
Preparation for labor and delivery
and for parenting

Postpartum period
Factors affecting the
postpartal experience
Abruptness of the transition to
parenthood
Family’s individual and collective
experiences with childbearing and
childrearing
Family members’ role expectation

Postpartum period
Factors affecting the
postpartal experience
Sensitivity that increase the risk of
postparum complications include:
Preeclampsia or eclampsia
DM
Cardiac problems uterine overdistension
Abruptio placenta or Placenta previa
Precipitous or prolonged labor, difficult
delivery, extended period of time spent in
stirrups
Postpartum period
 NURSING
RESPONSIBILITIE
S

Postpartum period
 NURSING
RESPONSIBILITIES
Provide sensitive professional care
to the new parents, which
includes:
a. Accurate assessment of mother’s
physiologic and psychological status
b. Anticipatory guidance and health
teaching as needed

Postpartum period
 NURSING
RESPONSIBILITIES
Facilitate the family’s bonding
experience

Postpartum period
Physiological
changes of
Postpartum
period
 POSTPARTAL
BIOPHYSICAL CHANGES
A. REPRODUCTIVE SYSTEM
B. ENDOCRINE SYSTEM
C. CARDIOVASCULAR SYSTEM
D. RESPIRATORY SYSTEM
E. RENAL & URINARY SYSTEM
F. GASTROINTESTINALSYSTEM
G. MUSCULOSKELETAL SYSTEM
H. INTEGUMENTARY SYSTEM
Postpartum period
 REPRODUCTIVE
SYSTEM CHANGES
REPRODUCTIV
UTERUS VAGINA
E SYSTEM
LOCHIA PERINEUM
CHANGES
CERVIX BREAST

Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
uterus
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Uterus
Contracts firmly
Reducing its size by over ½;
remains this size for 2 days, then
decreases in size (involution)
Descends one finger breadth per
day
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Uterus
@ 10 to 14 days postpartum –
cannot be palpated abdominally
Returns to nonpregnant state by
4 to 6 weeks’ postpartum

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Uterus
Site of placental attachment
require - 6 to 7 weeks to heal
Endometrial regeneration require
6 weeks

Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
lochia
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Lochia
Discharge from uterus during the
first 3 weeks ff. delivery

Postpartum period
 Color Days Components

Lochia Dark red 1-3 Blood & cellular

rubra debris from
decidua
Lochia Pinkish 3-10 Mostly serum
serosa brown Some blood
Tissue debris
Lochia Yellowish 10-14 Leukocytes w/
alba white decidua
Epithelial cells
Mucus
Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
cervix
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Cervix
Becomes thicker and firmer
By end of first postpartal week – dilated –
1 cm
Complete cervical involution
3 to 4 months
Cervical os
From round to elongated
Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
vagina
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Vagina
Smooth and swollen
w/ poor tone after delivery
Rugae
Appear 3 to 4 weeks postpartum
Estrogen index
Return in 6 to 10 weeks
Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
perineum
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Perineum
Appear edematous & bruised after
delivery
Episiotomy or laceration may be
present

Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
abdomen
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Abdomen
Remain soft and flabby
Striae remain
But take a silvery-white appearance

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Abdomen
Diastasis recti
Separation of abdominal recti muscle
May occur w/ poor muscle tone

Postpartum period
REPRODUCTIV
E SYSTEM
CHANGES:
breast
Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Breast
Rapid drop in estrogen &
progesterone levels w/ increase in
secretion of prolactin after delivery

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Breast
Colostrum
Present @ time of delivery
Breast milk
Produced by 3rd or 4th postpartum
day

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Breast
Becoming larger & firmer
As lactation is established (primary
engorgement
w/ congestion subsiding in 1 or 2
days

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Breast
Prolactin stimulates alveolar
cells to produce milk

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Breast
Sucking newborns
Causes oxytocin release &
contractility of myoepithelial cells to
stimulate milk flow (let-down
reflex)

Postpartum period
REPRODUCTIVE SYSTEM
CHANGES
Breast
Average amount of milk produced
(24 hrs) increase over time:
First week: 6 to 10 oz
1 4oz
1 to = 34
weeks: ml
20 oz
After 4 weeks: 30 oz
680
204 ml
to 340 ml
1020 ml
Postpartum period
ENDOCRINE
SYSTEM
CHANGES
Postpartum period
 ENDOCRINE SYSTEM
CHANGES
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 ENDOCRINE SYSTEM
CHANGES
Ovulation & return of menstruation
influenced by:
Lactating
45% resume menstruation by 12 weeks
80% have one or more anovulatory cycles
before the first ovulation

Postpartum period
 ENDOCRINE SYSTEM
CHANGES
Ovulation & return of menstruation
influenced by:
Nonlactating
40% resume menstruation by 6 weeks after
delivery
65% by 12 weeks & 90% by 24 weeks
50% ovulate during first cycle

Postpartum period
 ENDOCRINE SYSTEM
CHANGES
Estrogen & Progesterone level
Rapid drop ff. delivery of placenta
Responsible for ana. & physio.
changes in puerperium

Postpartum period
 ENDOCRINE SYSTEM
CHANGES
Requirements for rest and
sleep increase significantly

Postpartum period
CARDIOVASCULA
R SYSTEM
CHANGES

Postpartum period
 CARDIOVASCULAR
SYSTEM CHANGES
Transient bradycardia
40 to 70 bpm
Occurs 24 to 48 hrs after delivery
May persist for first 6 to 8 days

Postpartum period
 CARDIOVASCULAR
SYSTEM CHANGES
Blood volume
Decreases to nonpregnant levels by
2 weeks after delivery

Postpartum period
 CARDIOVASCULAR
SYSTEM CHANGES
Hematocrit level
Rises by 3rd to 7th postpartum day

Postpartum period
 CARDIOVASCULAR
SYSTEM CHANGES
Leukocytosis level
20,00 to 25,000 WBC/mL
Continues for several days after
delivery to prevent infection

Postpartum period
 CARDIOVASCULAR
SYSTEM CHANGES
Blood pressure
Remains stable
Pulse
Returns to nonpregnant rate by 3
months postpartum

Postpartum period
RESPIRATORY
SYSTEM
CHANGES
Postpartum period
 RESPIRATORY SYSTEM
CHANGES
Pulmonary functions return to
nonpregnant status by 6 months
after delivery

Postpartum period
RENAL &
URINARY
SYSTEM
CHANGES
Postpartum period
 RENAL & URINARY
SYSTEM CHANGES
Overdistension of bladder
Common due to:
Bladder capacity
Swelling
Bruising of tissues around the urethra
Diminished sensation to increased
pressure
Postpartum period
 RENAL & URINARY
SYSTEM CHANGES
Full bladder
Displaces the uterus
Can cause postpartum hemorrhage
Bladder distension
Can lead to urinary retention
Decrease rapidly after delivery

Postpartum period
 RENAL & URINARY
SYSTEM CHANGES
Adequate bladder emptying
Generally resumes 5 to 7 days after
tissue swelling and bruising resolve

Postpartum period
 RENAL & URINARY
SYSTEM CHANGES
Glomerular filtration rate
Remains elevated for 7 days after
delivery

Postpartum period
 RENAL & URINARY
SYSTEM CHANGES
Dilated ureters & renal pelvis
Elevated to their nonpregnant state 6
to 10 weeks after delivery

Postpartum period
 RENAL & URINARY
SYSTEM CHANGES
Puerperal diaphoresis & diuresis
Occur w/in first 24 hrs after delivery

Postpartum period
GASTROINTESTINA
L SYSTEM
CHANGES

Postpartum period
 GASTROINTESTINAL
SYSTEM CHANGES
Hunger and thirst
Common after delivery

Postpartum period
 GASTROINTESTINAL
SYSTEM CHANGES
GI motility & tone
Return to nonpregnant state w/in
2 weeks after delivery

Postpartum period
 GASTROINTESTINAL
SYSTEM CHANGES
Constipation
Commonly occurs during the early
postpartum period

Postpartum period
 GASTROINTESTINAL
SYSTEM CHANGES
Prepregnant weight
Returns in 6 to 8 weeks
If weight gain was in N range

Postpartum period
 GASTROINTESTINAL
SYSTEM CHANGES
Hemorrhoids
Common problem in early postpartal
period
Due to pressure on the pelvic floor
and straining during labor

Postpartum period
MUSCKULOSKELETAL
SYSTEM CHANGES

Postpartum period
 MUSCULOSKELETAL
SYSTEM CHANGES
Ambulate 4 to 8 hrs after
delivery
Early ambulation ( ENCOURAGED) to
avoid:
Complications
Promote involution
Improve emotional outlook
Postpartum period
 MUSCULOSKELETAL
SYSTEM CHANGES
Pelvic articulation
Relaxation and increased mobility
Occurs 6 to 8 weeks after delivery

Postpartum period
INTEGUMENTAR
Y SYSTEM
CHANGES

Postpartum period
INTEGUMENTARY SYSTEM
CHANGES
Melanin
Decrease gradually after delivery
Causing decrease in
hyperpigmentation

Postpartum period
INTEGUMENTARY SYSTEM
CHANGES
Visible vascular changes
Disappear as estrogen levels
decrease

Postpartum period
STUDY
WELL
Psychological
changes of
Postpartum
period
 POSTPARTAL
PSYCHOSOCIAL ADAPTATION
A. ESSENTIAL CONCEPTS
B. TAKING-IN PERIOD
C. TAKING-HOLD PERIOD
D. LETTING-GO PERIOD
E. POSTPARTUM DEPRESSION

Postpartum period
 ESSENTIAL
CONCEPTS
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 ESSENTIAL
CONCEPTS
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 ESSENTIAL
CONCEPTS
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-HOLD PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-HOLD PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
TAKING-HOLD PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
LETTING-GO PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
LETTING-GO PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
LETTING-GO PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 POSTPARTUM
DEPRESSION
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 POSTPARTUM
DEPRESSION
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 POSTPARTUM
DEPRESSION
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period
 Nursing
Management
of Normal
PPP
Nursing Management of
Normal PPP
Assessment
Nursing diagnoses
Planning and Implementation
Evaluation

Postpartum period
ASSESSME
NT
Postpartum period
 NURSING
DIAGNOSES
Postpartum period
PLANNING
IMPLEMENTATIO
AND

Postpartum period
EVALUATION

Postpartum period
 Refer
References
ences


Reffe
erences


Referenc
es
Reference
s
Maternal & Child Health Nursing
5th edition, 2004
Adele Pillitteri
Reference
s
Essentials of Maternity Nursing
The nurse and the child bearing
family 2nd edition, 1987
Irene M. Bobak
Margaret Duncan
Jensen

* very
understandable
Reference
s
Myles Textbook for Midwives
11th edition, 1989
V. Ruth Bennett
Linda K. Brown
Reference
s
• Williams Obstetrics 19th edition,
1993
F. Gary Cunning
Paul C. McDonald
Norman F. Gant
Kenneth J. Leveno
Lary G. Guilstrap III
STUDY
WELL