POSTPARTUM

PHASES OF PUERPERIUM

🟆 TAKING-IN PHASE
- is a time of reflection
- a woman is largely passive
- (2-3 days) - prefers having a nurse minister
- to her, making decisions, rather
- than do things herself - the woman rests to regain
- strength
- encourage woman to talk
- about the birth

🟆TAKING-HOLD PHASE
- the woman begins to initiate action
- prefers to get her own washcloth and to make her own decisions
- this time is best to give a woman brief demonstrations of baby care
- allow woman to care for her child herself with watchful guidance

🟆LETTING GO PHASE
- the woman finally redefines her new role
- gives up fantasized image of her old role of being child or the
mother of only one or two

PHYSIOLOGIC CHANGES OF POSTPARTAL PERIOD

SYSTEMIC CHANGES

➢ HORMONAL SYSTEM
■ Pregnancy hormones begin to decrease as soon as the placenta is no
longer present
■ Levels of hCG and hPL are almost negligible by 24 hours
➢URINARY SYSTEM
■ Increase daily urine output of a postpartal woman from a normal level of
1,500 ml to 3,000ml/day during 2nd-5th day after birth
■ Assess woman's abdomen frequently in the immediate postpartal period:
● On palpation: a full bladder is felt as as a hard or firm area just
above the symphysis pubis
● On percussion: a full bladder sounds resonant
➢CIRCULATORY SYSTEM
- BLOOD LOSS
- VAGINAL BIRTH - 100-500 ml
- CESAREAN BIRTH - 500-1000ml
➢GASTROINTESTINAL SYSTEM
- Digestion and absorption begin to be active again soon after birth
- Presence of Hemorrhoids
- Difficult bowel evacuation due to episiotomy sutures and
hemorrhoids
➢INTEGUMENTARY SYSTEM
- Striae Gravidarum become reddened
- Chloasma and Linea Nigra will become barely detectable in 6 weeks
- Diastasis Recti will appear slightly indented

REPRODUCTIVE SYSTEM CHANGES

● UTERUS
- INVOLUTION :
●Two main processes:
a. the area where the placenta was implanted is
sealed off to prevent bleeding
b. the organ is reduced to its approximate
pregestational size
● LOCHIA
a. Lochia Rubra
b. Lochia Serosa
c. Lochia Alba
● CERVIX
a. AFTER BIRTH
- soft and malleable
- internal and external os are open
b. BY THE END OF 7 DAYS
- feels firm and nongravid
- the external os has narrowed (pencil opening)
○ VAGINA
- After a vaginal birth:
a. the vagina is soft with few rugae and its diameter is
considerably greater than normal
b. the hymen is permanently torn and heals with
small, separate tags of tissue
● PERINEUM
- Feels edematous and tender immediately after birth
- Ecchymoses from ruptured capillaries may show the
surface
- Labia majora and labia minora typically remain atrophic
and softened after birth