MIDTERMS  An elevation above 140/90 mmHg may indicate
pregnancy-induced hypertension, or postpartum
CARE OF THE MOTHER AND
CHILD (CAMCA)
POST PARTUM:
MONITORING VITAL SIGNS, UTERINE
INVOLUTION, AMOUND AND PATTERN OF
LOCHIA, EMOTIONAL RESPONSES, RESPONSES
TO DRUG THERAPY, EPISIOTOMY HEALING
 MONITORING VITAL SIGNS
 Vital sign changes in the postpartum period
reflect the internal adjustments that occur as
the woman’s body return to its pre-pregnant
state.
 Check the mother’s vital signs, i.e. her
temperature, pulse rate, and blood pressure,
and make sure they are within the normal
range. Straight after the birth, check her pulse
and blood pressure at least once every hour,
and her temperature at least once in the first six
hours.
 TEMPERATURE
 Is always taken orally or tympanically (never
rectally) during the puerperium, because of the
danger of vaginal contamination and the
discomfort involved in rectal intrusion.
 Increase in temperature during the first 24
hours after birth because of dehydration that
occur during labor.
 The mothers temperature should be close to
36-38 degrees celsius ( 97.2-100.4 F) during
the 24-hour period.
 If the mothers temperature rises above 38
degrees celsius
 (100.4 F), excluding the first 24-hour period, it
is considered febrile. In such cases, a
postpartal infection may be present.
 Infection is a major cause of postpartal
mortality and morbidity. Because nurses play a
major role in assessing postpartum
temperature,they have the important role of
being the health care providers who may first
detect infection.
 PULSE RATE
 Pulse rate during postpartal period is usually
slightly slower than normal.
 Pulse rate to between 60 and 80 bpm.
 Rapid and thready pulse during postpartal
period could be a sign of hemorrhage.
 BLOOD PRESSURE
 The mothers systolic blood pressure should be 90-
135 mmHg, and her diastolic blood pressure should
be 60 to 85 mmHg.
hypertension, an unusual but serious complication
of the puerperium.
 UTERINE INVOLUTION
 Involution: is the process whereby the
reproductive organs (both anatomically and
functionally) return to their non-pregnant state
after childbirth or postpartum period.
 Uterine involution: is a physiological process
by which the uterus turns to its pre-pregnancy
dimensions with
 endometrial regeneration, reduced uterine
blood flow and endometrial vascularity, and
reduced muscle mass
 The uterus decreases in size at a predictable
rate during postpartal period. After 10 days, it
recedes under the pubic bone and is no longer
palpable.
 Occurs by 6–10 days postpartum.
 Involution involves the clamping down of the
uterine myometrium, a process that is
accompanied by menstrual cramp–like pain
that varies from mild to very severe.
 This six-week process, can sometimes be a
painful one. Also referred to as afterpains—
short, sharp, cramps that you may feel in your
abdomen a couple of days after giving birth,
often while nursing—are the sensation of your
uterus contracting, which helps expel blood
clots.
 AMOUNT AND PATTERN OF LOCHIA
 LOCHIA - VAGINAL DISCHARGE
 Lochia is the vaginal discharge you have after
a vaginal delivery. It has a stale, musty odor
like menstrual discharge.
 For the first 3 days after birth, a lochia
discharge consists almost entirely of blood,
with only small particles of decidua and
mucus. Because of it’s mainly red color, it is
termed Lochia Rubra. As the amount of blood
involved in the cast-off tissue decreases about
the fourth day and leukocytes begin to invade
the area, as they do with any healing surface,
the flow becomes pink or brownish in color,
termed as Lochia Serosa. On about the tenth
day, the amount of the flow decreases and
becomes colorless or white yellowish, termed
as Lochia Alba.
 An increased lochia when you get up in the
morning, when you are physically active, or
while breastfeeding can also be noticed. Moms
who have cesarean sections may have less
lochia after 24 hours than moms who had
vaginal deliveries. The bleeding generally
stops within 4 to 6 weeks
  after delivery. You should wear pads, not
tampons, as nothing should go in the vagina
for six weeks.
 The postpartum woman should not experience
sudden increase in bleeding, especially fresh
bleeding associated with clots. In such
circumstances, she should quickly consult her
obstetrician.
 EMOTIONAL RESPONSES
 Caring for an infant is hard work. It can be
hard to adjust to the chaos a new baby brings
to a household. Constantly focusing on baby's
needs can be exhausting.
 Most women feel they have to make a major
adjustment. The postpartum period involves
more than becoming comfortable with the role
of mother.
 POSTPARTUM “BABY BLUES”
 About eight in 10 new mothers feel down after
giving birth. The "baby blues" occur during the
first few days after birth, usually appearing on
the third or fourth day. They are usually over
by two weeks postpartum.
 A mother may feel tearful, impatient, irritable,
restless or anxious. These periods are fairly
short and don't last all day. The feelings come
and then go away by themselves. The mother
may also feel extremely fatigued (tired) due to
 a lack of sleep. Taking naps can help her feel
better.
 POSTPARTUM DEPRESSION
 It is estimated that almost one in five new
mothers experiences various degrees of
postpartum depression. This often appears
around the fourth week after birth. It can also
begin just before your period returns, after
weaning or anytime in the first year.
 During the recovery, the Mother may feel
tired, overwhelmed, stressed, have feelings of
loss of her identity, and have less control over
her time. These can also add to the postpartum
depression.
 The mother may have one or several of these
symptoms:
 Nervousness, anxiety, panic, restlessness
 Sluggishness, fatigue, exhaustion
 Sadness, hopelessness, irritability
 Eating and sleeping problems
 Poor concentration, confusion, memory
loss
 Over-concern for your baby
 Lack of interest in your baby
 Feelings of guilt, inadequacy,
worthlessness
 Exaggerated highs, lows, or both
 Fear of harming your body, yourself or
both
 Symptoms can be mild or so severe that the
mother can feel like "going crazy." With
depression, she may have "good" days and
"bad" days. These feelings don't go away by
themselves, and it needs help and support.
 Symptoms are treatable with medicine, talk
therapy or both. Talk with health care
provider about what you are feeling.
The Mother may also
 Rest as much as possible.
 Don't put pressure on yourself to do everything.
 Ask for help with chores and night feedings.
 Talk with family and friends about how you are
feeling.
 Get out of the house.
 Spend time with your partner.
 Talk with other mothers.
 Join a support group.
 Avoid other major life changes during this time.
 RESPONSES TO DRUG THERAPY:
ANTIDEPRESSANTS
 Antidepressants affect certain brain chemicals
called neurotransmitters. There are lots of
antidepressants. Some types work on different
brain chemicals than others.
 Bupropion (Wellbutrin, Zyban)
 Escitalopram (Lexapro)
 Fluoxetine (Prozac, Sarafem)
 Paroxetine (Paxil, Pexeva)
 Sertraline (Zoloft)
 Amitriptyline (Elavil)
 Desipramine (Norpramin)
 Doxepin (Deptran, Sinequan)
 Tranylcypromine (Parnate)
 Trimipramine (Surmontil)

 IV Medication
 Sometimes, symptoms can get severe and the
doctor may consider hospitalization. A drug
called brexanolone that is given by IV over
several days might help. There is a risk of
excessive sedation and sudden loss of
consciousness.
SIDE EFFECTS OF ANTIDEPRESSANTS
 Nausea or vomiting
 Dizziness
 Restlessness
 Sexual problems
 Trouble sleeping
 Weight gain/weight loss
 Headaches
 Diarrhea
 Dry mouth
 Blurry vision
 Constipation
 Trouble emptying your bladder
 Feeling tired
 Bigger appetite and weight gain
 Dizziness when you stand up
 Increased sweating
 Antidepressants have shown up in breast milk in
very low amounts.
 Studies have found that neither the old or new
drugs have harmful
 effects on babies when small amounts are passed
through breast milk.
 EPISIOTOMY HEALING
 Episiotomy
 an incision made between the vagina and
the rectum in order to increase the size of
the opening of the vagina and facilitate the
delivery of a baby
 The National Institute for Health and Care
Excellence (NICE) recommends that an
episiotomy might be done if:
 the baby is in distress and needs to be
born quickly, or
 there is a need for forceps or vacuum
(ventouse), or
 there is a risk of a tear to the anus
 This may be necessary if:
 you're having a breech birth
 you have been trying to give birth for
several hours and are now tired after
pushing
 you have a serious health condition, such
as heart disease and it's recommended that
delivery should be as
 quick as possible to reduce further health
risk.
 RECOVERING FROM AN EPISIOTOMY
 Episiotomy cuts are usually repaired within an
hour of the baby's birth. The cut may bleed
quite a lot at first, but this should stop with
pressure and stitches. Stitches should heal
within 4-6 weeks of the birth
 EPISIOTOMY CARE
 ACTIVITY:
 Rest when you feel tired.
 Be active. Walking is a good choice.
 Allow your body to heal. Don't move
quickly or lift anything heavier than your
baby until you are feeling better.
 Ask your doctor when you can drive
again.
 You may shower and take baths as usual.
 Pat the incision dry when you are done.
 You will have some vaginal bleeding.
Wear sanitary pads. Do not douche or use
tampons until your doctor says it is okay.
 Ask your doctor when it is okay for you to
have sex.
 DIET
 You can eat your normal diet.
 Drink plenty of fluids (unless your doctor
tells you not to).
 If your bowel movements are not regular
right after surgery, try to avoid
constipation and straining.
 Drink plenty of water. Your doctor may
suggest fibre, a stool softener, or a mild
laxative.
 MEDICINES
 Your doctor will tell you if and when you
can restart your medicines. He or she will
also give you instructions about taking
any new medicines.
 If you take aspirin or some other blood
thinner, ask your doctor if and when to
start taking it again. Make sure that you
understand exactly what your doctor
wants you to do.
 Be safe with medicines. Read and follow
all instructions on the label.
 INCISION CARE
 Put ice or a cold pack on the sore area for
10 to 20 minutes at a time. Put a thin cloth
between the ice and your skin.
 Sit in a few centimeters of warm water
(sitz bath) 3 times a day and after bowel
movements. The warm water helps with
pain and itching. It may feel better to dry
the area with a hair dryer instead of a
towel.
 After you use the toilet, pour or spray
warm water over your vagina and anus.
This will help keep the area clean.
 After a bowel movement, it may feel
better to wipe with baby wipes or
medicated pads, such as Tucks.