Postpartum care

Maternal Adaptation During

Postpartum Period Weight loss
Physiologic adaptation
Reproductive system ❖ Immediate 12 to 14 lb = baby, placenta, and
❖ Uterine contraction leads to amniotic fluid
involution(shrinking of the uterus ❖ 5 to 15 lb (early postpartum) = fluid loss from
❖ Measured by assessing fundal height diaphoresis, urinary excretion
❖ Factors promote, inhibit involution ❖ Return to prepregnancy weight six months after
❖ Afterpains childbirth (if within recommended weight gain
range)

assessment/ education ❖ In general, the breastfeeding woman tends to

lose weight faster than the woman who does not
Assess fundal height: Assess the location, breastfeed because of increased caloric
consistency, and height of the fundus through palpation. demands.
❖ If the uterus is not firm upon palpation,
massage it gently. Placing the infant on the
mother’s breast also aids in stimulating
Nursing interventions for
contractions.
postpartum care after cesarean birth
Assessment
Lochia: blood, mucus, tissue, WBC compose uterine Primary causes of maternal mortality post cesarean
discharge ❖ Anesthesia complications
❖ Rubra: first 3-4 days, small-mod amount, ❖ Postpartum infection
mostly blood and dark red with fleshy odor ❖ Hemorrhage
❖ Serosa: days 4-10, decreases to small amount, ❖ Thromboembolism
brownish/pink color Monitor
❖ Alba: after day 10, white-pale yellow, mostly ❖ Lungs; signs of respiratory depression
❖ IV for Sources of pain
WBCs ❖ PCA
Ovaries ❖ discomfort
❖ Ovulation can occur as soon as three weeks ❖ Incision; bowel sounds; urinary output
❖ Signs of thrombus formation
post-delivery
Cervix
❖ Vagina, perineum
❖ Never fully return to pregravid state; Kegel

❖
exercises
Lactation can lead to vaginal dryness, Nursing management & Discharge
Breasts
dyspareunia (painful intercourse)
planning
❖ Colostrum; prolactin ❖ Preventing injury from Rh-negative blood type or non immunity
Cardiovascular system to rubella
❖ High plasma fibrinogen levels and other ❖ Is the woman a candidate for Rho(D) immune globulin
coagulation factors mark postpartum period (RhoGAM) I'M within 24 hours of delivery. Given and checked
Vital signs as if you were administering a blood product.
❖ Temperature may be slightly elevated first 24 ❖ Providing patient teaching
❖ Breast care; fundal massage
hours
❖ Perineum and vaginal care
❖ Slow pulse a first, then WNL first week post
❖ Pain management
delivery ❖ Nutrition; constipation
❖ Blood pressure should not be elevated ❖ Proper rest
For every 250 mL of blood loss, the hemoglobin and ❖ Stress importance of prioritizing self-care
hematocrit (H&H) fall by one and two points, ❖ MMR (subq) right before DC if needed
respectively. So, if the woman’s H&H were 12 and 34, ❖ Evaluation: Goals and expected outcomes
then fall to 10 and 30, the approximate blood loss is
500 mL.
❖ Musculoskeletal system: Abdomen is soft,
sagging immediately postpartum
❖ Gastrointestinal system: Very hungry;
constipation
❖ Urinary system: Transient glycosuria,
proteinuria, and ketonuria are normal
immediately postpartum
❖ Voiding issues
❖ Integumentary system: Copious diaphoresis
common
❖ Striae (stretch marks) on abdomen and breasts