Maternity

1st PP what is Maternity Nursing?

You care for them prenatally and they might assist with fertility
1-2 days after a normal birth and 3-4 days if it is a C-section birth
Labor and Delivery nurses triage just like the ER, anybody over
20 weeks get sent to the Labor and Delivery immediately just in
case they are ready to give birth
Pitocin can be given or turned away by the nurse they do not
need an order
Maternity Nursing Issues
High cost and limited access to care
Fertility rate (due to infertility), birth rate, prematurity (happen at a
high rate), Low birth weight infants
Complimentary Medicine and Therapies
Many women use complimentary medicine
Informed consent id different (they are emancipated) if above 13 they
can decide on what they want to do in their pregnancy
Facts About Intimate Partner Violence (IPV)
Pregnant women are constantly screened for this because this is when
they are most vulnerable
All women are at high risk
Violence and pregnancies happens when there is something wrong
Direct Affects can cause spontaneous abortion
Indirect effects can cause maternal stress and maternal smoking
Normal Newborn PP CH 24-25 Recording 2
Newborns are nose breathers
Respirations is the first thing we have to work with first because the
baby is slightly hypoxic and this is not necessarily a bad thing because
it stimulates the brain to breath
We would clear the mouth first (make sure the airway is clear
because they can aspirate)
Then we dry the baby (put the baby on the moms chest and then
the nurse will dry the baby)
Sometimes they leave the baby on top of the mom and they can
do the Apgar score
If the score is under 7 we will resuscitate the baby even if they
have respirations and cardiac function we still call it resuscitate
(we never put an oxygen mask on a baby because it can stop
their breathing) just rub the baby or tap the baby on the back.
We would draw blood from the cord so they can find out the babys
blood type and they would do ABG if they feel like the baby is
compromised
Then put in warmer and further assessment is done

Neonatal Transitioning
Independent respirations
Glucose Stabilization (they get too cold and metabolize the
brown fat and cannot control their body temperature) large
babies born over 4g we need to make sure we stabilize them
because they can have hypoglycemia
Changes begin immediately after birth; the cutoff time when the
transition is considered over (although the baby keeps changing)
is 28 days. This transition period has three phases: first
reactivity, decreased response, and second reactivity. All
newborns experience this transition period, regardless of age or
type of birth. Although stress can cause variations in the phases,
the mothers age and wealth do not disturb the pattern.

The normal heart rate for infants who are not sleeping is 120 to
160 beats per minute. However, a crying infant could temporarily
have a heart rate of 180 beats per minute. Heart murmurs during
the first few days of life have no pathologic significance;
however, an irregular heart rate beyond the first few hours
should be further evaluated. Persistent tachycardia may indicate
RDS; bradycardia may be a sign of congenital heart blockage.
The WBC count is normally high on the first day of birth and then
rapidly declines
The newborns flexed position guards against heat loss, because
it reduces the amount of body surface exposed to the
environment. The newborns body is able to constrict the
peripheral blood vessels to reduce heat loss. Burning brown fat
generates heat. The respiratory rate may rise to stimulate
muscular activity, which generates heat.
A newborn who has not voided in 24 hours may have any of a
number of problems, some of which deserve the attention of the
pediatrician
Telangiectatic nevi (stork bites, angel kisses) fade by the second
year and have no clinical significance
Respiratory Adaptation
Mechanical chest compressions (during labor the baby is moving
through the birth canal it is getting squeezed so with a normal vaginal
delivery they tend to be junky that they have a lot of fluid) where as a
precipitous delivery happens fast and will not get a lot of compressions
or a C-section baby these types of babies need a lot of suctioning
Chemical (slightly hypoxic which will stimulate the body to balance it
and breath) higher levels of CO2)

Surfactant is a chemical produced in the body, which will act as a

lubricant for the lungs (alveoli will not open up if they do not have this
and will not be able to fill with air) (this develops at 28 weeks and
peaks at 35 weeks)
Thermal (abrupt alteration in temperature) (they cannot control their
temperature)
Sensory (tactile stimulation of the baby)
Cardiovascular Adaptation (circulation is controlled by mom)
Oxygen levels will go up and increased pressure in blood, which will
lead to these shunts to be closed
Clamping of the cord and we will go from there
Closure of fetal shunts
Foramen ovule- increased pulmonary blood flow from the left
side of the heart increases pressure in the left atrium, which
causes a functional closure of the foramen ovale (located in the
septum between the right and left atria closes minutes after
birth due to elevated left ventrical pressure)
Duct us Arteriosis (is the vessel connecting the pulmonary
trunk to the aorta) this closes within 10- 15 hours after birth and
blood is pumping the blood out of the body
Ducts Venous us (second branch of the umbilical vein but the
process of how it closes is not understood but they believe they
close by constriction closure of the vessels) usually happens
within four days after birth
If these do not close the baby will have congenital issues *
Other physiologic adaptations
Thermoregulation (we want to maintain their temperature
97.5-98.9 F) skin to skin is the best way to maintain temperature
and we will dry the baby and put blankets on top) (most of heat
loss of the baby is because of the environment) (has increased
metabolic rate) skin is very thin and also has undeveloped shiver
mechanisms
Peripheral vascular constrictions because the blood is being
shunted to the vital organs so they will have cyanosis which is
not a bad thing
Brown fat metabolism (scapula fat pads)
How can we know when a baby is hypothermic? Blanching and
paleness of the skin, they will not be able to shiver and if they are in a
warmer we need to put them on a continuous temperature and we
leave them in their diaper only not blankets because they can overheat
If the baby is too cold they can become hypoxic, Acidosis,
hypoglycemia. One reason we do not use Demerol for the baby it

will affect their ability to metabolize brown fat or their

thermoregulation
Convection is the flow of heat from the body surface to cooler
ambient air
Conduction is the loss of heat from the body surface to cooler
surfaces, not air, in direct contact with the newborn
Evaporation is a loss of heat that occurs when a liquid is converted
into a vapor
Evaporation, conduction, convection (take the heat off the baby and
puts it in the air), radiation (sitting side by side by someone else) most
of the time we consider it not indirect
GI
They must have the suck swallow ability in order for them to survive
they must be able to nurse (if they are able to suck and not able to
swallow it can cause aspirations) 32-34 weeks of gestation usually this
occurs thats why this problem is common for babys that are born
preterm
Full term neonate intestines and pancreas are immature must
produce enough of the enzymes to be able to digest (we need to
give them something simple) breast milk is must better because
they digest it better whereas infant formula they do not
completely break it down so they will be fed less constantly
Do not feed solid foods until 6 months but they want you to wait
a year (do not give them water because they can choke and do
not give them honey for the first year of life)
Stomachs can hold up to 50-60 mL at the very most (system is
very immature so there is a lot of reflux and burping)
When the baby is born they usually do not have bowel sounds so
the first effective bowel sounds will come after 24 hours
Babys are less acidic than adults they are more alkalitic
(metabolism will be slower because of this)
Salvatore glands do not work like the adults but develop after 3
months (we try to feed the baby as soon as possible after birth)
(bonding as far as baby and mom they need to fed the baby as
soon as possible)
Meconium is greenish black and viscous and contains occult
blood (Meconium stool is usually passed in the first 12 hours of
life, and 99% of newborns have their first stool within 48 hours. If
meconium is not passed by 48 hours, then obstruction is
suspected. Meconium stool is the first stool of the newborn and is
made up of matter remaining in the intestines during intrauterine
life. Meconium is dark and sticky. This can result in cystic fibrosis
if this does not pass

Transitional stool is greenish-brown to yellowish-brown and

usually appears by the third day after the initiation of feeding
The presence of excessive saliva in a neonate should alert the
nurse to the possibility of a tracheoesophageal fistula or
esophageal atresia. Excessive salivation may not be a normal
finding and should be further assessed for the possibility that the
infant has an esophageal abnormality.

Apgar Scoring System

A system used to assess the physical response of the newborn at birth
using five criteria
A score of 0-2 is given for each of the five assessments at 1 minute
after birth and at 5 minutes after birth
The individual scores are added together for a total score ranging from
0-10
A total score of 8-10 indicates a satisfactory response *
A total score of 7 or less indicates the need for resuscitation * (rubbing
or stimulating the baby
5 things scored
HR
Respiratory Effort (slow is the key word because irregular is the
norm)
Muscle Tone
Reflex irritability
Color
Stats
Normal Newborn Weight 2500g-4000g(if less than 2500 small
gestational age) over 4000 g it is LGA
In pounds 5.5 - 8.8
Length (baby is on the warmer you extend the baby heels and
mark and put a little mark on the head and then you measure
from the side (19-21 inches) 48-53 cm
Head circumference (33-35cm) (13in-14in) the head should be
2 cm larger than the abdomen for normal proportion
Chest Circumference (30.5-33cm) 12-13 inches (measure at
nipple line)
Temp 36.5-37.5 or 97.5-98.9 (axillary temperatures)
RR 30-60
HR 110-160
Do not normally get the BP (get it on the leg it they have too)
Physical Examination

General Survey
Skin
Should be smooth and pink (when they cry they get circum ora)
all babys are pale when they are born
Capillary hemangioma strawberrys they are raised areas or
flat pink red spots (they can grow and usually will go away but
sometimes they do stay)
Harlequin (fast delivery when half the blood vessels are dilated
and the other side is constricted but it is not an emergency
situation but will usually last up to 20 minutes and go away)
vernix caseosa white kind of cheesy substance on the skin
which allows for lubrication and protects the skin (after 35
weeks)
Lanugo might also be found on their skin still, which is hair (at
the end of gestation the amniotic fluid will lessen)
Acrocyanosis- is normal and appears intermittently over the
first 7-10 days especially with exposure to air
Cutis marmorata (its transient modeling of the skin and get web
looking red veiny and this is not uncommon)
Erythema toxicum- a transient rash or flea bite rash, Red but
then you have white crusty papule on top usually on top of the
chest or abdomen (not harmful of the baby)
Milia (raised white sebaceous glands and will resolve over the
first month)
Mongolian spots (bluish color mainly over the buttocks or lower
back)
Hydrocele- caused by an accumulation of fluid around the
testes
Head
Molding (the shaping of the fetal head by overlapping of the cranial
bones to facilitate movement through the birth canal during labor),
bruising
Skeletal System
Caput succedaneum (it puts pressure on the head as the pelvis
pushes it down to the cervix) (this is two words so it crosses the
sutures) (edematous are of the scalp due to compression of the
local vessels which therefore results in slower venous return
resulting in edema
Cephalhematoma (pressure on the head and does not cross
suture line it is usually one or another) (is a collection of blood
between a skull bone and its periosteum) (usually disappears
after 2-3 weeks)

The visual system continues to develop for the first 6 months

after childbirth

Might be a little misshaped (for the baby to come out the birth canal)
you will see the fontanels and should not see any bulging of the
fontanels
Eyelids can be edematous and there are bony structures
Transient strabismus (eye muscles are immature so this can be
normal in the early stages) nystagus is also possible
Positive red reflex (can respond to sound) mucous drainage, which is
normal, but they do not have tears (scleral hemorrhages)
Ears should be well shaped and midline and have to be proportionate
with the canthus of the eyes
Nares (patent and their soft and hard palates should be hard)
Rub in the side of the cheek they turn to the side of the cheek
White dots on their gums are normal which are called Bohn
We palpate the clavicles to make sure there are no crepitation or
breaking of the clavicles
We are looking for any tenderness, mass, or shortening of the neck
(down syndrome, turner syndrome)
Neonates are barrel chest; they might have milky secretion on both
male and female, which resolve within a couple weeks
Xiphiod process might be visible since they have no fat in the
sternum
Axillary nipples
Lungs
Cardiac (check all pulses) auscultate the abdomens but we wont have
bowel sound for the first 24 hours
The testes will be edematous
They can have a period due to high levels of estrogen form the mom
and we have to make sure placement of the urinary meatus is in the
correct position (foreskin is on the top of the meatus sometimes) if it is
adhered it is called femosis) we palpate the scrotum to check if they
are descended and if they are not we palpate to check and feel them
to move them down
We do take blood from the newborn
Congenital testing 54 conditions
The only ones they check for in 50 states is PKU which can cause death
to the baby
Blood screening (any baby who is above or lower weight will have a
glucose testing because they run a high risk for hypoglycemia)
If a temp is extremely low we will also take a glucose testing
(standard protocol is if its 50 or below they treat the baby
immediately)
Confirmation of hearing loss does not come after 3 months

Hepatitis B vaccine will be administered usually before discharge

and after 2 months after as well
Identifying possible complications
Ballard Scale
Newborn Reflexes
Sucking and Rooting (4-7 months this will disappear)
Touch infants lip, cheek, or corner of mouth with nipple or finger
Normal Finding- infant will turn toward stimulus and open mouth
Swallowing
Feed infant
Grasp (palmar and plantar) (usually disappears after 8 months)
Palmar
Place finger in palm of hand
Normal finding
Curls over examiners hand
Plantar
Place finger at base of toes
Normal finding
Toes curl downward
Tonic Neck/Fencing (3-4 months)
With infant in supine position turn head quickly to one side
Normal finding
With infant facing left side, arm and leg on that side extend;
opposite arm and leg flex
Moro
Hold infant in semi sitting position, allow head and trunk to fall
backward to angle of at least 30 degrees with support then place
infant supine on flat surface; perform sharp hand clap
Normal finding
Baby responses immediately to sound and noise but usually
disappears after 6 months
Stepping (4-8 weeks)
Hold infant vertically in arms allowing one foot to touch down the
surface
Normal finding
Infant will stimulate walking
Crawling
Place newborn on abdomen
Normal finding
Newborn makes crawling movements with arms and legs
Babinski (dorsal flexion of the foot and the toes spread out wide)
disappears by 12 months

Pupillary (PERRLA)
Rooting
Trunk incurvation (Galant)
Place infant in prone position and run finger down back about 45cm lateral to spine, first on one side and then the other
Normal finding
Trunk is flexed and pelvis is swung toward stimulated side
Continuation of Newborn Assessment PP Recording 3
Newborn Behavioral Assessment
Sleep States
Deep sleep (eyes are closed, no eye movement, even breathing,
lower HR between 100-120, sudden jerking movement, difficult
to awaken) post delivery there are in a deep sleep at this period
Light sleep (REM takes place in this still, may be moving their
legs, feet, suck their tongue, stimuli resulting in startle reflex
may cause them to wake up_
Drowsy (this can fall in both categories) (awake to sleep)
Awake States
Active Alert (Frequent activity, thrashes their head, vocalize and
make noises, increase startle response at this time, movement of
extremities)
Quiet alert (just hanging out but they are taking it all in not much
movement)
Habituation (ability to ignore repeated disrupted stimuli to a
degree where newborn wrestles into caregivers body)
Console ability to self soothe but they need to learn to self sooth
and if they cannot it can be a sign that something is wrong with
the baby
Crying
Drowsy (sleepy to awake)
Immediate post delivery care of the newborn
Skin to skin contact with the mother (covered warm blanket, or
placed under radiant warmer
Suction infants mouth and nose with bulb syringe (or catheter to
wall suction)
At birth we do not want to console that baby because we want
them to cry to open up their airways
Dry infant immediately and rewrap in clean, warm blanket
When they cut the cord they use two clamps
Apgar scoring
Note any presence of any abnormalities
Adequacy of respirations and heart rate
Weight, length, head circumference

Vitamin k 0.5 mg IM into the front of the thigh and is given within the
first hour or two (we only inject in the thigh), eyes prophylaxis, blood
glucose as necessary (parents can refuse both the medications)
Blood gas is not always done in the baby and this is done through the
cord
Blood glucose is check for less than 37 weeks gestation
20 weeks is a viable pregnancy (if you miscarry at 19 weeks it is
considered a specimen)
Newborn identification and security measures
Thermoregulation
We must maintain the bodys temperature to maintain
metabolism and
Convection lose heat through air
Radiation lost heat from an object
Evaporation heat loss from moisture
Physical care of the newborn continued
We always want to keep the cord nice and dry and monitor for
nay bleeding, we fold the diaper underneath it so it can dry
Clean the diaper area with mild warm water with soap in the area
Circumcision can be cleaned with warm soapy water
Feeding (breastfeeding is the optimal type of feeding for infants)
Feedings
The sooner we start to feed the baby we will enhance the GI system,
and reduced the time that meconium is in the bowel, the longer it
stays in he body the harder it will take to take it out, we are aiding with
metabolism and bilirubin
Formula feeding
Preparation and storage
Do not prop bottles or feed in supine position
Cleaning bottles, nipples
On demand feeding versus feeding schedules
No honey or corn syrup
Benefits of Breastfeeding
Reduces allergies and childhood obesity and reduces chances of
asthma
Breastfeeding benefits in women include breast cancer, ovarian
cancer, and osteoporosis
Breast milk for the hospitalized infant can be stored in the refrigerator for only 8
days, not for 3 months. Breast milk can be stored in the freezer for 3 months, in a
deep freezer for 6 months, or at room temperature for 4 hours. Human milk for
the healthy or preterm hospitalized infant can be kept in the refrigerator for up to
8 days or in the freezer for up to 3 months, but only for 4 hours or less at room
temperature.

Breast milk is fresh in the refrigerator for 8 days, can be frozen for 6
months, if you defrost it is good for 24 hours, it does separate like the
milk that comes out will always be thinner and liquidy and usually
meant to thirst quench the baby
Formula is composed of cow milk, whey, and amino acids (you cannot
freeze formula) all bottles should be sterilized when reusing
Storage- formula 2 hours 24-48 hours (opened formula)
Normal breastfeeding will nurse 1-2 hours every (we want to
encourage them to nurse on both sides of the breast) with formula
eveyr3-4 hours the baby will nurse Psychosocial care of the
newborn
Bonding
Bets facilitated during the quiet alert state
We want to affectively handle stress because the baby can sense
We want to educate the parents to realistic expectations
Normal Postpartum PP Recording 3 CH 20
Puerperium- period from delivery of the placenta and membranes to
return of the reproductive system to pre-pregnancy state
Lochia is the blood that comes out but it is a discharge
Greater than 1 cm we will monitor but if it is around 2cm we will
notify the physician but before we leave the room we will check
the fundus because it will be bleeding so therefore causing clots
We will feel the fundus first to make sure it is firm and make sure
that it is not mushy which can signify some bleeding
Maternal Postpartum physiologic adaptation: Reproductive system
Uterus has to go through a process: involution
Return to normal, pre-pregnancy condition
If it is the first baby it will usually go back to normal but the more
babies you have it will have a hard time going back to normal
At delivery the fundus is around the umbilicus or 1 cm above. The
uterus after post delivery it will go down 1 cm and at 1 week it will go
back to normal
They will have cramping (if the mother is breastfeeding it will
release oxytocin and will cause the uterus to contract therefore
decreasing the chance of bleeding so this is good)
Usually non-breastfeeding women will begin to ovulate around 6 weeks
but it is not guaranteed so we always stress birth control, for a
breastfeeding women it will come back in 8 weeks but most of the time
they do not ovulate but they can still get pregnant so we have to stress
this to the patient
Cervix does go back to normal but it is still edematous and remains
dilated 2-3 cm for approx. three days post delivery and its size will
change in structure, in 6 weeks it will close up again but it will never be
completely sealed again

Fundal Height
Immediately after delivery at the umbilicus or slightly above the
umbilicus
1 hour postpartum at the umbilicus
6-12 hours- midline of umbilicus
1 day postpartum 1 cm under umbilicus
To palpate we will put the hand around the umbilicus and cup the
fundus and we are massaging it and we never stick our fingers (If
the patient had a C-section we would support the incision while
we are cupping the fundus, we would also inspect and assess the
incision by redness, edema, ecchymosis, t, a
Lochia rubra- may contain small clots, for the first 2 hours after
birth there will be a lot of bleeding but the lochia flow will
decrease with time. Dark red and consists mainly of blood and
decidual and trophoblastic debris.
Lochia Serosa- pink or brown after 3-4 days (consists of old
blood, serum, WBC, and tissue debris.
In most women about 10-14 days after birth the drainage
becomes yellow to white which is called lochia alba consists of
WBC, fat mucus, cholesterol crystals, white creamy yellow but it
is kind of thick

Different in ways we chart we chart Lochia

Scant (2.5 cm tiny little bit)
Light less than 4in
Moderate less than 6 in
Heavy (saturated pad in one hour)
Excessive (excessive drainage in 15-30 minutes)
Usually lasts 2-4 days
We use the same rubric
As far as strengthening the muscles
Vagina- kegel exercises
Perineum- intact, lacerations, episiotomy (procedure cute the vaginal
opening)
Perinatal lacerations stages
Foucquet is the opening layer of the skin opens first-degree
laceration of the vagina
Second degree involves perinatal skin, vaginal mucous
membrane, underlying fascia, partial of the muscle wall and may
extend upward and bilaterally
Third degree laceration involves vaginal mucus membrane and
perinatal body, reaches the interior wall of the rectum
Fourth degree laceration-

Non-lactating women will revert back to normal size after a week or

two
If they have engorgement we want them to use ice packs, limited
stimulation so that the prolactin levels goes down and the milk
will go down, when they shower just let the water run, they can
also use cold cabbages and promote less stimulation as possible
Lactating women we want them to stimulate the breast, feed the
baby every 1-2 hours so that prolactin levels rise
Colostrum usually there after birth
We have to tell the women that they will feel engorged after 3-4
days; they need to have the mouth cover most of the areola with
them
When the nipples crack and the areola we suggest they use their
own colostrum but no Vaseline. Warm water w soap and let airdry
When they breastfeed oxytocin is released and they will have
contractions
Continuation of Post-Partum PP Recording 4
Plasma and blood level increases during pregnancy
The heart will resume its normal position in the thorax (during
pregnancy the heart is kind of pushed to the left side but it will move
back towards the midline) the diaphragm will be able to go to its
normal position once again
In the first 15 min cardiac load increases form 60-80% (we have to
evaluate each patient who is giving birth with cardiac problems) then it
decreases over the next 6 weeks
1 hr. after birth cardiac starts to decrease and will return to prepregnancy 1-2 weeks after
Blood volume: vaginal 200-500 ml, c section 500-1000 ml of blood lost,
the volume decrease secondary to diaphoresis and urination, it is not
uncommon for women to wake up drenched due to hormonal changes,
urination (increases tremendously) during epidural they will be getting
fluid and will not be feeling to go to the BR so we will have to monitor
this and make sure they regain feeling for them to void, we massage it
and see if it contracts, if there is bladder distention we want to check
the uterus since it can move it, it can also lower H&H, 4-6 weeks
plasma volume goes back to normal, during pregnancy you have
relaxation of all the vessels which can cause varicosities (a women can
have a C-section and still have a varicose vein in the perinea area)
spider red lines do not usually disappear but is due to the increased
pressure, if a women doesnt have normal diaphoresis we would want
to look for the heart since it will backup and cause pulmonary edema
Post-Partum the tempter of the mother will have an increased
temperature since they just gave birth

H&H
Hematocrit will drop 2-4 points with 500 mL of blood loss*; it will
increase back to normal in 3-7 days, hemoglobin 1-1.5 drop with 500
mL of blood loss (this takes a little longer to return usually 4-8 weeks,
acceptable level is 10 because it can drop slightly during pregnancy
Coagulation increases after birth so we have to monitor them for DVT
(will usually return back to normal in 6-7 days) platelets will drop
WBC count 25-30000 is not uncommon usually due to the level of
granulocytes and will usually decrease back to normal levels within a
week
BP (should range pre-pregnancy level) still might b elevated with
pregnancy induced hypertension so we have to monitor this, Blood
sugars will go back up right after pregnancy, sometimes the BP will
never go back to normal, when a women is pregnant if a normal person
is 110/80, the blood pressure can drop,
HR during pregnancy is slightly elevated and might have slight
bradycardia after delivery just because of the blood loss or you can
have tachycardia because of the bleeding but it should be roughly the
pre-labor HR
RR can go back to normal baseline and usually there is 16-24 RR
Temp is slightly increased because they might not be eating or drinking
during labor or the anesthesia as well
As far as hormones HcG is the hormone that is secreted during
pregnancy to stay pregnant and will stay in the body after a week of
pregnancy, human placental lactogen tends to increase maternal blood
so once the placenta is not in the body it will not produce it (it controls
the metabolism of maternal glucose*), Post delivery their sugars tend
to drop, breastfeeding women is different since their constant
metabolism so their sugars end to be low, progesterone is no longer
measurable 72 hours post-pregnancy and will drop drastically (once
the women starts menstruation they can be detected, estrogen is key
in a women and when they drop this is when they are diaphoretic,
estrogen in the post partum are influenced] by breastfeeding and non
breastfeeding will start to menstruate again in 6 weeks, prolactin is
what produces the milk and will remain high if they are breastfeeding,
usually within a week or 2 weeks the milk will dry up and the prolactin
levels will be low
Pulmonary function immediately returns after pregnancy
Acid-Base during pregnancy they are more alkali tic and will go back to
normal within 3 weeks
Oxygen consumption remains elevated for two-week post delivery
GI (they are very hungry and we can let them eat or drink after giving
birth during normal vaginal delivery) not usually a huge meal because
the GI system is slowed down because they can feel nauseas
The bowels are often delayed 2-3 days and we have to monitor this
because the thought of having a bowel movement is petrifying to them

since the area Is sore and we want them to increase their fluid intake
and want them to ambulate as much as possible, most women get a
stool softener, women who have a C-section we want to make we are
listening to bowel sounds and increase fluids but we want to make sure
they are able to go home and be constipated. If they have an epidural
they usually start eating a little bit earlier (normal standard NPO we
follow) weight loss with delivery 10-12 lbs., after a week they lose 5-8
lbs. first week postpartum, we absolutely want to encourage them to
return to their normal weight
Urinary system (there may be trauma in the urinary meatus we have to
know how long they were pushing for in the delivery) bladder capacity
increases but the sensation of filling decreases immediately after birth,
trauma or anesthesia can decrease the control of the bladder filling,
they are at risk for increased distention and will cause the uterus to
fully contract and lead to hemorrhage, normal kidney function goes
back 4-6 weeks post delivery, abdominal muscles go back to normal
with exercise after 6 weeks and takes 2-3 months after the delivery
Diastasis Recti Abdominals (vertical splitting of the abdomen) it can
split up to 2-4 cm, we want them to wear a binder if they want to
exercise,
Stretch marks (at first they are red arks then turn white, and this is not
preventable due to the breakdown of the elastic fibers of the skin,
darker skin people they turn blackish or brown) they can happen
anywhere in the body
Immunization (rubella) those with result of a negative must not
become pregnant 28 days because it can be teratogenic to the fetus,
usually given before they leave, they should be tested for immunity
after 3 months to test these levels, breastfeeding women can still get
this vaccine, if the patient if immunocompromised we will think twice
Rh-negative moms get rhogam at 28 weeks during pregnancy and 72
hours before they leave home (it is to reduce the antibodies so they do
not become sensitized and make the baby feel as an outsider)
Post-partum
H&H is usually drawn 6 hours after delivery and once before they go
home
We do a CBC because we want to look at platelets and WBC and we do
a urinalysis is done and we might do a toxic drug screen
BUBBLEHEPP
In all postpartum assessments we want to listen to listen to the
Respirations if they had a C-section, magnesium, or respiratory issues
prior to delivery
Heart sounds
We want to make sure they are going to the bathroom and measure
the amount of urine (with a C-section we need two people to help them
get out of bed)

Nutrition (they should not diet within the first 6 weeks postpartum and
the entire time they are breastfeeding) 500 extra calories for milk
production,
Family responses to Birth PP Recording 4
Know the difference of definitions
Know what family role and structure*
Health beliefs (go by the chart in the book) what different cultures feel?
Developtmenaetal task (parenthood) stabilization of family unit,
resolving conflicts, maintaining relationships, impact on extended
family relationship
Acquaintance phase
Know rubins maternal attainment** PG 508
Role as a nurse we should provide family-centered care