COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

RESOURCE UNIT ON
PHYSIOLOGIC CHANGES OF THE POSTPARTAL PERIOD

SUBMITTED BY:
Capuyan, Jean Loury
Colonia, Noelle V.
Delara, Krishna Faith P.

SUBMITTED TO: Ms. April Rose Estela, RN

 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

NEGROS ORIENTAL STATE UNIVERSITY

VISION: A dynamic, competitive and globally responsive state university.
MISSION: The University shall provide excellent instruction, relevant and responsive research and extension services, and quality assured production through competent and highly motivated
human capital.

GOALS:
Negros Oriental State University strives to advance:
National development through international partnerships
Opportunity-laden educational access for poor but deserving students
Research-based and competency-driven instruction
Scholarship and innovation
Unity and diversity in culture
CORE VALUES: QUALITY POLICY:
Spirituality NORSU: commits itself to the
Accountability provision of quality instruction,
Professionalism research, extension services and
Patriotism production as well as compliance
Harmony to applicable regulatory
Integrity requirements and continual
Respect improvement of its management
Excellence system
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

CNPAHS VISION:
NORSU College of Nursing, Pharmacy and Allied Health Sciences (CNPAHS) as an educational institution to become the premiere provider of health care education in the country and
across the world.
CNPAHS MISSION:
Provide excellent instructions thereby developing competent future health leaders and practitioners who are intellectually and humanely responsive, self-directing and contributing
members of the society.
CNPAHS GOALS:
 Develop innovative approaches towards achieving quality teaching, research, service, and practice goals.
 Contribute to the knowledge base of the discipline through an active program of health care and interdisciplinary research that are responsive to the changing health needs of the
population.
 Cultivate the attitudes and skills necessary to think critically, manage information and assume accountability for independent decisions.
 Maintain an awareness of the historical trends, legal, social, economic, political and trans-cultural issues related to total health care education and practice.
CNPAHS OBJECTIVES:
 To synthesize theoretical and empirical knowledge from the general education subjects with professional subjects to produce competent graduates.
 To equip would-be health leaders and workers with comprehensive knowledge and skills in administering health services in various health settings.
 To motivate the faculty and students to undertake cutting edge research that will enhance the quality of human life and contribute to national and global development.
 To maintain collaborative and cooperative partnership with the community through health care programs and extension services.
 To value every individual as a unique and adaptive person who has worth and dignity and who engages in dynamic and reciprocal interaction with the environment.
 To collaborate with health consumers and providers in promoting, maintaining and restoring health and facilitate the provision of accessible, cost-effective, quality health care.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

BACHELOR OF SCIENCE IN NURSING PROGRAM OBJECTIVES

The students shall be given opportunities to be exposed to the various levels of health care (health promotion, disease prevention, risk reduction curative and restoration of health) with
values client (individual, family, population groups and community). These opportunities shall be given in graduated experiences to ensure that the competencies per course, per level and for the
whole program are developed. Before graduation, the student shall the competencies of a professional nurse as they assume the various roles and responsibilities. For each year level the following
shall be achieved.
LEVEL II
At the end of the second year, the student shall have acquired the holistic understanding of the human person as a bio-psycho cultural being focusing on the concept of health and illness as
it is related to the care of the mother and the child in varied settings. Specifically, the students shall:
1. Describe the health care delivery system and nurse’s role in it.
2. Demonstrate ethico-moral legal responsibilities in the care of individual, family, and community.
3. Demonstrate the beginning skills in the provision of the independent and collaborative nursing function.
4. Discuss the role of economics as it impacts on health and illness.
5. Relate the stages of growth and development in the care of the clients.
6. Demonstrate the beginning skills in the preparation of healthy and therapeutic diets in varied client cases.
7. Explain the dynamics of the disease process caused by microbes and parasites, and the environment.
8. Imbibe the core values cherished by the nursing profession such as love of God, caring, love and community and of people.
9. Design a plan that will focus on health promotion and risk reduction to clients.
10. Utilize the nursing process in the care of the high-risk mother and child in the family and in the community.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

TOPIC TITLE Physiologic Changes of the Postpartal Period

This topic deals with the concepts related to nursing care of a family having various physiologic changes
during postpartal period. It includes the changes in reproductive system, as well as changes on other system
TOPIC DESCRIPTION
throughout the body of the woman. Moreover, this includes the retrogressive and progressive changes of the
puerperium and the return of menstrual flow of the mother.
TIME ALLOTMENT 30 minutes
PLACEMENT 1st Semester, SY 2021 – 2022
PARTICIPANTS BSN Level II Postpartum Group 1
ROTATION POSTPARTUM/PRENATAL/NURSERY/CHN/LRDR
At the end of 30 minutes of varied teaching-learning activities, the learners will be able to demonstrate
GENERAL
excellent knowledge on the various changes in different systems in the body and the puerperium, explain the
OBJECTIVES
core principles of the topic, and adhere to the provision of quality care of a family during postpartal period. ,
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

TEACHING-
TIME
CONTENT/TOPIC SPECIFIC OBJECTIVES LEARNING MATERIALS EVALUATION
ALLOTMENT
ACTIVITIES
PHYSIOLOGIC CHANGES OF THE POSTPARTAL PERIOD
At the end of the 30 minutes
I. Reproductive System Changes discussion learners will be able
 Involution is the process whereby the reproductive organs to:
return to their nonpregnant state.
A. The Uterus  Identify the changes in  30  Focused and  Powerpoint  Instant
 Involution of the uterus involves two processes. First, the the Reproductive minutes Lecture Presentation Feedback
area where the placenta was implanted is sealed off to system that occurs in Discussion with Video  15- items quiz
prevent bleeding. Second, the organ is reduced to its the postpartal period Clips  Oral
approximate pregestational size. of a woman. Assessment and
 The sealing of the placenta site is accomplished by rapid Recitation
contraction of the uterus immediately after delivery of the
placenta.
 The same contraction process reduces the bulk of the
uterus. Devoid of the placenta and the membranes, the
walls of the uterus thicken and contract, gradually
reducing the uterus from a container large enough to hold
a full-term fetus to one the size of a grapefruit.
 Involution will occur most dependably in a woman who
is well nourished and who ambulates early after birth as
gravity may play a role.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

B. Lochia
 Lochia is the vaginal discharge after giving birth,
containing blood, mucus, and uterine tissue. Lochia
discharge typically heavy at first and rapidly decreases in
amount and describes in three phases: lochia rubra,
lochia serosa and lochia alba.
 Lochia rubra, menses-like bleeding (red in color) in the
first few days consisting mainly of blood, fragments of
decidua and mucus. Lochia serosa, a lighter discharge
(pink in color) in the next days consisting of blood,
mucus, and invading leukocytes. Lochia alba, a whitish
discharge (white) that may persist for 6 weeks and consist
of largely mucus and leukocytes.

C. The Cervix
 In contrast to the process of uterine involution, in which
the changes consist primarily of old cells being returned
to their former position by contraction, the process in the
cervix does involve the formation of new muscle cells.
Because of this, the cervix does not return exactly to its
pre-pregnancy state. The internal os closes as before, but
after a vaginal birth, the external os usually remains
slightly open and appears slitlike or stellate (star
shaped), whereas previously it was round.
Normal After birth
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

D. The Vagina
 After a vaginal birth, the vagina feels soft, with few
rugae, and its diameter is considerably greater than
normal. The hymen is permanently torn and heals with
small, separate tags of tissue. It takes the entire postpartal
period for the vagina to involute (by contraction, as with
the uterus) until it gradually returns to its approximate
pre-pregnancy state.

Hymen

E. The Perineum
 Because of the great amount of pressure experienced
during birth, the perineum is edematous and tender
immediately after birth. Ecchymosis patches from
ruptured capillaries may show on the surface. The labia
majora and labia minora typically remain atrophic and
softened after birth, never returning to their pre-
pregnancy state.

II. Systemic Changes

A. The Hormonal System

 Pregnancy hormones begin to decrease as soon as the  Determine the
placenta is no longer present. Levels of human chorionic different systemic
gonadotropin (hCG) and human placental lactogen (hPL) changes in the body.
are almost negligible by 24 hours.
 By week 1, progestin, estrone, and estradiol are all at pre-
pregnancy levels (estriol may take an additional week
before it reaches pre-pregnancy levels). Follicle
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
stimulating hormone (FSH) remains low for about 12
days and then begins to rise as a new menstrual cycle is
initiated.

B. The Urinary System

 During pregnancy, as much as 2,000 to 3,000 ml of excess
fluid accumulates in the body so extensive diaphoresis
(excessive sweating) and diuresis (excess urine
production) begin almost immediately after birth to rid the
body of this fluid. This marked increase in urine
production causes the bladder to fill rapidly.

C. The Circulatory System

 The usual blood loss with a vaginal birth is 300 to 500 ml
but with a cesarean birth, it is 500 to 1,000 ml.
 Women have high level of plasma fibrinogen during the
first postpartal weeks as they did during pregnancy. This is
a protective measure against hemorrhage however, this
high level also increases the risk of thrombus formation.
 There is also an increase of leukocytes as high as 30,000
cells/mm 3 compared to a normal level of 5,000 to 10,000
cells/mm 3 in the blood. This is part of the body’s defense
against infection and an aid to healing.

D. The Gastrointestinal System

 Digestion and absorption begin to be active again soon
after birth unless a woman has had a cesarean birth. The
woman feels hungry and thirsty, and she can eat without
difficulty from nausea or vomiting during this time.
 Bowel sounds are active, but passage of stool through the
bowel may be slow because of the still-present effect of
relaxing on the bowel. Bowel evacuation may be difficult
because of pain if a woman has episiotomy sutures or from
hemorrhoids.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

E. The Integumentary System

 After birth, the stretch marks on a woman’s abdomen
(striae gravidarum) still appear reddened and may be even
more prominent than during pregnancy, when they were
tightly stretched.
 Excessive pigment on the face and neck (chloasma) and
on the abdomen (linea nigra) will become barely
detectable by 6 weeks’ time. If diastasis recti
(overstretching and separation of the abdominal
musculature) occurred, the area will appear as a slightly
indented bluish streak in the abdominal midline.

III. Retrogressive Changes of the Puerperium

A. Exhaustion
 As soon as birth is completed, a woman experiences total
exhaustion. All during labor, she worked hard with little or  Describe the
no sleep. Now she has “sleep hunger,” which may make it retrogressive changes
difficult for her to cope with new experiences and stressful in the puerperium of a
situations until she has enjoyed a sustained period of sleep. woman.

B. Weight Loss
 The rapid diuresis and diaphoresis during the second to
fifth days after birth usually result in a weight loss of 5 lb
(2 to 4 kg), in addition to the approximately 12 lb (5.8 kg)
lost at birth. Additional weight loss is dependent on the
amount of pregnancy weight gain and on whether a
woman continues active measures to lose weight.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

C. Vital Sign Changes

i. Temperature
 A woman may show a slight increase in temperature
during the first 24 hours after birth because of dehydration
that occurred during labor. If she takes in adequate fluid
during the first 24 hours, this temperature elevation will
return to normal. If the elevation in temperature lasts
longer than a few hours, however, infection is a more
likely reason.

ii. Pulse
 A woman’s pulse rate during the postpartal period is
usually slightly slower than usual. After birth, to
accommodate the increased blood volume returning to the
heart, stroke volume increases. This increased stroke
volume reduces the pulse rate to between 60 and 70
beats/min. As diuresis diminishes the blood volume and
causes blood pressure to fall, the pulse rate increases
accordingly. By the end of the first week, the pulse rate
will have returned to normal.

iii. Blood Pressure

 Blood pressure should also be monitored carefully during
the postpartal period, because a decrease in this can also
indicate bleeding. In contrast, an elevation above 140
mmHg systolic or 90 mmHg diastolic may indicate the
development of postpartal hypertension of pregnancy, an
unusual but serious complication of the puerperium.

IV. Progressive Changes of the Puerperium

A. Lactation
 The formation of breast milk (lactation) begins in a
postpartal woman whether or not she plans to breastfeed.  Characterize the
Early in pregnancy, the increased estrogen level produced progressive changes of
by the placenta stimulated the growth of milk glands; the puerperium.
breasts increased in size because of these larger glands,
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
accumulated fluid, and some extra adipose tissue.
 Breast milk forms in response to the decrease in estrogen
and progesterone levels that follows delivery of the
placenta. In many women, breast distention becomes so
marked it is accompanied by a feeling of heat or throbbing
pain, or breast tissue may appear reddened. This feeling of
tension in the breasts after birth is termed primary
engorgement. It fades as the infant begins effective
sucking and empties the breasts of milk.

V. Return of Menstrual Flow

 With the delivery of the placenta, the production of
placental estrogen and progesterone ends. The resulting
decrease in hormone concentrations causes a rise in  Explain how the return
production of FSH by the pituitary, which leads, with only of menstrual flow
a slight delay, to the return of ovulation. This initiates the occur after giving
return of normal menstrual cycles. birth.

Differentiating changes in a postpartum and normal woman

Postpartum Normal

 Increase in size of hips.  Normal size of hips.

 Breast Engorgement and
enlargement because of milk
production.
 Postpartum Bleeding (Vaginal
Bleeding)
 Uterus slowly back into normal
size
 Normal size of breast.
 Monthly Menstrual Bleeding
 Normal size of uterus
 No presence of stretch marks in
the abdomen
 Still have mood swings since it
can be affected by other factors
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

 Lose skin and stretch marks  Slight hair loss due to other
 Mood swings because of factors.
decreased hormones after  Normal bowel movement
delivery
 Hair Loss
 Constipation due to present
effect of relaxing to bowel or
pain in episiotomy sutures or
hemorrhoids.

Learning Environment: BSN LEVEL 2

Resources: Non-Print Reference Materials, Electronic Equipment and Supplies
Course Requirements:
• Attendance in 30 minutes discussion.
• Active participation in the discussion

Course Grading System /Evaluation Tools:

The learning outcomes in learners will be determined by their active participation in the forms of:
• Oral Assessment & Recitation
• 15 items quiz

REFERENCES:
Pillitteri, A. (2014). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Philadelphia: Lippincott Williams & Wilkins.