POSTPARTUM PERIOD 5.
The placenta site heals by means of
Physical Changes of Postpartum Period
1. The postpartum period is defined as that
period of time, usually six weeks, in which the
mother’s body experiences anatomic and
physiologic changes that reverse the body’s
adaptation to pregnancy; may also be called
Involution.
2. Begins with the delivery of the placenta and
ends when all the body systems are returned to,
or nearly to, their prepregnant state.
3. May or may not include the return of the
ovulatory/menstrual cycle. (some cause of
breastfeeding ; a missed or skipped feeding will
ovulate.)
4.
Specific Body System Changes Reproductive
System
A. Uterus: A rapid reversal in size.
1. Palpated after delivery below the umbilicus,
the uterus regresses approximately 1
fingerbreadth (1cm) per day until, by the end
of the second week postpartum it is a pelvic
organ and cannot be palpated through the
abdominal wall.
2. The process is accomplished by cell size
reduction.
3. The endometrial surface is sloughed off as
lochia, in three stages:
a. Lochia rubra – dark red color, days
1-3 after delivery; consists of blood
and cellular debris from decidua.
b. Lochia serosa – pinkish brown, days
4-10; mostly serum, some blood,
tissue debris.
c. Lochia alba – yellowish white, days
11-21; mostly leukocytes, with
decidua, epithelial cells, mucus.
Sub Involuted Vaginal bleeding, Blood clots
Uterus
Puerperal Sepsis Infection ; endometrial lining
is still open.
After birth pains Strong Uterine Contraction /
or after pains Mostly multipara or delivery
large baby ; deliver ng twins;
breast feed last for only 3
days.
4. Lochia has a particular, musty odor. Foul
smelling lochia, however, may indicate
infection. Some small clots may be normal
immediately after delivery; large cots signify
the need for close investigation.
exfoliative shedding; a process that allows
the upward growth of the new endometrium
and the prevention of scar tissue at the old
placental site. This process may take six
weeks.
B. Cervix:
1. Flabby, immediately after delivery; closes
slowly.
2. Admits one fingertip by the end of one week
after delivery.
3. Shape of the external os changed by the
delivery from round to slitlike opening.
C. Vagina:
1. Edematous after delivery
2. May have small laceration
3. Smooth-walled for 3-4 weeks, then rugae
reappear.
4. Hypoestrogenic until ovulation and
menstruation resume.
D. Ovulation/menstruation:
1. First cycle is usually anovulatory.
2. If not lactating, menses may resume in 4-6
weeks.
3. If lactating, menses less predictable, may
resume in 12-24 weeks.
E. Breast:
A. Nonlactating woman
1. Prolactin levels fall rapidly.
2. May still secrete colostrum for 2-3
days.
3. Engorgement of breast tissue resulting
from temporary congestion of veins and
lymphatic circulation occurs on third
day, last 24-36 hours, usually resolves
spontaneously.
4. Client should wear tight bra to compress
ducts and use cold applications to reduce
swelling.
B. Nonlactating woman
1. High level of prolactin immediately,
after delivery of placenta continued by
frequent contact with nursing baby.
2. Initial secretion is colostrum, with
increasing amounts of true breast milk
appearing between 48-96 hours.
3. Milk “let-down” reflex caused by
oxytocin from posterior pituitary release
by sucking.
4. Successful lactation results from the
complex interaction of infant sucking
 reflexes and the maternal production and
let-down of milk.
F. Abdominal Wall/Skin
1. May need six weeks to reestablish good
muscle tone.
2. Stretch marks gradually disappear or fade to
silvery appearance.
G. Cardiovascular System
1. Normal blood loss in delivery of single infant
is less than 500 cc (up to 1000 cc normal
blood loss for a c-section.
2. Hematocrit usually returns to prepregnancy
value within 4-6 weeks.
3. WBC count increases.
4. Increased clotting factors remain for several
weeks leaving woman at risk for problems
with thrombi
5. Varicosities regress
H. Urinary System
1. May have difficulty voiding in immediate
postpartum period as a result of urethral
edema.
2. Voiding reflex may be altered
3. Mark diuresis begins within 12 hours of
delivery; increases volume of urinary output
as well as perspiration loss.
4. Lactosuria may be seen in nursing mothers.
5. Many women will show slight proteinuria
during first 1-2 days of involution.
I. Gastrointestinal System
1. Mother usually hungry after delivery; good
appetite is expected.
2. May still experience constipation from lack of
muscle tone in abdomen and intestinal tract
and perineal soreness.
J. Other
All other systems experience normal and rapid
regression to prepregnancy status.
Postpartal Psychosocial Changes
ADAPTATION TO PARENTHOOD
MOTOR SKILLS
New parents must learn new physical skills
to care for infant (e.g. feeding, holding, burping,
and changing diapers, skin care)
ATTACHMENT SKILLS
A. Bonding: the development of a caring
relationship with the baby. Behaviors
include
1. Claiming – identifying the ways in
which the baby looks or acts like
members of the family.
2. Identification – establishing the baby’s
unique nature (assigning the baby his or
her own name)
3. Attachment – is facilitated by positive
feedback between baby and caregivers.
B. Sensual Responses enhance adaptation to
parenthood
1. Touch – from fingertip, to open palm, to
enfolding; touch is an important
communication with the baby.
2. Eye-to-eye contact – a cultural activity
that helps to form a trusting relationship.
3. Voice – parents await the baby’s first
cry; babies respond to the hinger pitched
voice that parents use in taking to the
baby.
4. Odor – babies quickly identify their own
mother’s breast milk by odor.
5. Entrainment – babies movies in rhythm
to patterns of adult speech.
6. Biorhythm – babies respond to maternal
heartbeats.
MATERNAL ADJUSTMENT
Takes place in three phases
1. Dependent / “Taking In”
1. 1-2 days after delivery
2. Mother’s needs predominate, mother
passive and dependent.
3. Mother needs to talk about the labor and
delivery experiences to integrate them
into the fabric of her life.
4. Mother may need help with everyday
activities as well as childcare.
5. Food / sleep important.
2. Dependent / Independent / “Taking Hold”
1. By third day mother begins to reassert
herself.
2. Identifies own needs, especially for
teaching and help with her own and
baby’s needs.
3. Some emotional liability, may cry “for
no reason”
4. Mother requires reassurance that she can
perform tasks of motherhood.
3. Independent / “Letting Go”
1. Usually evident by fifth or sixth week.
2. Shows pattern of lifestyle that includes new
baby but still focuses on entire family as
unit.
 3. Reestablishment of father-mother bond seen prepare individual bottles and
in this period. formula.
4. Mother may still feel tired and TIPS FOR SUCCESSFUL BREAST FEEDING
overwhelmed by responsibility and BREAST CARE
conflicting demands on her time and - Do not use soap on nipple or areola.
energies. - Expose nipples to air to toughen them.
POSTPARTAL CHANGES ASSESSMENT - Know how pump breast milk if necessary
PHYSICAL and how to store expressed breast milk.
A. Vital Signs NUTRITION
1. Individual protocol until stable, then at - Need for good maternal nutrition while
least one every 8 hours. nursing
2. Temperature over 100.4 °F (37.8 °C) - Additional 500 kcal/day
after first 24 hours, lasting more than 48 - 2-3 liters fluid/day
hours, indicative of infection. - Know that certain foods may make the baby
B. Fundus fussy and will need to be avoided.
1. Should be firm, in midline, slightly Comfort
below umbilicus immediately after - Wear well-fitting bra, use absorbent packs
delivery. without plastic coating if leaking occurs.
2. After 12 hours should rise to level of the - Mild uterine cramping during nursing
umbilicus of 1 cm above. normal at first.
3. Should regress 1 cm/day thereafter until Medications
end of second week - Avoid medications excreted in breast milk
4. Assessment should always be done with (mother should check with physician before
client’s bladder empty. taking any drugs while nursing) Birth
C. Lochia: color, amounts, clot, odor control pills should not be taken while
D. Perineum nursing (decreases milk production)
1. Healing of episiotomy Sources of help
2. Hematoma formation - Inform mother of community support
3. Development of hemorrhoids system available for nursing mother.
INTERVENTIONS
A. Choices in Newborn nutrition
1. Formula feeding (bottle-feeding):
utilizes modified cow’s milk, goat’s milk
or soy formulas as basis for provision of
20kcal/oz.
1. Formulas are widely available in
ready-to-feed, concentrated or
powdered forms.
2. They have supplemental vitamins;
may also contain added iron.
3. Concentrated and powdered forms
require addition of prescribed
amounts of water for appropriate
reconstitution.
4. Sterilization of prepared formulas
may be recommended; methods are
a. Terminal Heating Method –
formula and bottles prepared
using clean technique; entire batch
sterilized at end of preparation.
b. Aseptic Method – sterile
technique and sterile water used to