Post Partum Period

NURSING CARE ON FOURTH STAGE

1. Assess fundus
2. Check for bleeding
3. Check the bladder
4. Check the perineum
5. Take vital signs every 15 minutes
6. Promote rest
 NEONATAL PERIOD
1. Airway
wipe mouth and nose
suction
stimulate to cry
oxygen administration
hook to respiratory machine

2. Temperature
dry the baby
wrap with towel
goose neck lamp
avoid unnecessary exposure
place inside incubator
3. Proper identification
name bond
foot prints

4. Care of the cord

milking the cord
cord dress aseptically

5. Care of the eyes

Crede’s prophylaxis (prevents ophthalmia neonatorum)
- Terramycin

6. Vitamin K injection
7. Newborn assessment
APGAR scoring - done on the after 1 and 5mins of life

0 1 2

Heart rate Absent <100 >100

RR Absent Slow/irregular Good cry

Muscle tone Absent/limp Some flexion Active

Reflexes No response Grimace Cry

Color Blue/pale Acrocyanosis All pink

 0 1 2
Activity/muscle tone Absent/limp Some flexion Active

Pulse Absent <100 >100

Grimace/ Reflexes No response Grimace Cry

Appearance/color Blue/pale Acrocyanosis All pink

Respiratory rate Absent Slow/irregular Good cry

 SCORE INTERPRETATION
0-4 = Poor
• in serious danger and needs
resuscitation

5-6 = condition is guarded

• may need airway clearing
and oxygen

7-10 = good
• newborn is doing well
8. Anthropometric measurements

Birth weight = 2.5-3.5 kg

Length = 48-53 cm
Head circumference = 33-35 cm
Chest circumference = 31-33 cm
Abdominal circumference = 28-30 cm

9. Vital signs

Heart rate = 120-160 bpm

Respiratory = 40 – 60 bpm
Temp(rectal) = 36.5 - 37.5
10.Head to toe assessment

a. Head
moldings
fontanels
caput succedaneum
cephalhematoma
suture lines
anencephaly

b. Face
blink reflex
strabismus
ears should be even or above outer eye canthus
MOLDINGS
CAPUT SUCCEDANUM CEPHALHEMATOMA
c. Chest = witch milk

d. Abdomen = check the umbilical cord

= gastroschisis –absence of abdominal wall

e. Genitals
= should void within the 1st 24 hours
= pseudomenses
= testes should be descended (cryptorchidism- undescended testes)
= preterm male has less rugae in the scrotum
= labia minora is prominent
f. Extremities
= flexed
= creases on the palm (Simean
crease- only one crease)
= polydactyly - extra toes or
fingers
= syndactyly – webbing of fingers
= amelia - absence of one or
more limbs
= clubfoot
g. Skin
= color
= mongolian spots
= vernix caseosa
= lanugo
= milia
MONGOLIAN SPOTS
LANUGO
MILIA
ERYTHEMA TOXICUM
 PUERPERIUM
Termination of labor Involution

1. Maintain infection-free environment

2. Promote healing
3. Watch for bleeding
4. Encourage early ambulation
5. Provide comfort and rest
6. Provide emotional support
7. Establish successful lactation
 PHYSIOLOGIC CHANGES IN POST PARTAL PERIOD

1. Reproductive Changes

Uterus
= size is reduce:
immediately after delivery- 1000 gm
after end of 1st week - 500 gm
after 6 weeks - 50 gm
= placental site is sealed off
= cervical os are narrowed
= painful during contraction
= contracted
FUNDAL HEIGHT POST PARTUM

6-12 hours postpartum

Immediately after birth

Lochia
= discharges of the uterus
Lochia rubra
Lochia serosa
Lochia alba

= pattern should not reverse

= increase in activity
= decrease in breastfeeding
= not offensive in odor
= without large clots
= present in CS
Vagina
= soft, swollen
= hymen is permanently torn

Perineum
= edematous
= with laceration, episiorrhaphy
= labia minora and majora remains atrophic
Abdomen
= soft and flobby
= striae gravidarum lightens
= linea negra disappears in 6th week

Breasts
= drop in estrogen and progesterone
= lactating
= colostrum is present
= Let-down reflex
= warm and tender
= engorged
= milk is produced by the 3rd – 4th day
= veins are apparent
2. Systemic Changes
Hormonal
= after 1 week – prepregnant state

Urinary system
= voiding maybe difficult immediately after birth
= urinary retention
= after 12 hours – diuresis
= voiding time should be after 4-6 hours post partum

Circulatory system
= decrease blood volume
= return to normal at 1st – 2nd week
= blood loss : NSVD - 300-500 ml
CS - 500-1000 ml
= increase plasma fibrinogen
= increase WBC
Gastrointestinal system
= hungry and thirsty
= slow passage of stool
= positive bowel sounds
= difficult bowel evacuation

Integumentary system
= linea negra and chloasma barely detectable in 6th week
3.Vital Signs
Temperature
= increase on the 1st 24 hrs - dehydration
after 24 hours - infection
after 3-4 days - milk production
Pulse
= decrease due to decrease cardiac output

Blood pressure
= slightly decrease

Respiratory rate
= no changes
4. Retrogressive changes
Exhaustion
= sleeplessness
= fetal movements
= labor pains
= energy expenditures
= NPO

Weight Loss
= diuresis
= diaphoresis
= return to prepregnant weight at 6th week
5. Progressive changes
Lactation
THE MAMMARY GLAND
 PHYSIOLOGY OF MILK PRODUCTION AND EJECTION

Placental delivery Suckling

Decrease estrogen & progesterone

Stimulate PPG
Stimulates APG

PROLACTIN OXYTOCIN

Acini cells
Collecting tubules

Milk Production

Collecting tubules Milk ejection

LET-DOWN REFLEX
 HEALTH TEACHINGS FOR BREAST FEEDING
1. Hand washing before and after
2. Clean nipple with water
3. Expose nipple to air
4. Feed the baby in short frequent intervals and lengthen gradually
5. Alternate the breasts
6. Proper positioning
7. Adequate maternal nutrition and increase OFI
8. Wear well-fitted bra
 PROPER ATTACHMENT

a. Baby grasp not only the

nipple but also the areola
b.Lower lip turned outward
c. Chin of the baby touches
mother’s breast
 PROPER POSITIONING

a.Head and lower body part must be aligned

b.Baby is facing the mother
c.Tummy to tummy
The Clutch or Football Hold
Side-lying or Reclining Position
The Cradle Hold
The Cross-Over Hold
 BREASTFEEDING
Best for baby, also best for mommy
Reduces the incidence of allergies
Economical – no waste
Antibodies to protect baby against infection
Sterile and pure; stool inoffensive
Temperature is always ideal
 BREASTFEEDING
Fresh milk never goes off
Easy to prepare and to digest
Eradicates feeding difficulties
Develops mother and child bonding
Immediately available
Nutritionally optimal; No mixing required
Gastroenteritis greatly reduced
Post Partum Period
GOALS OF POSTPARTUM CARE
1. Promote normal uterine involution and return to the nonpregnant state.
2. Prevent or minimize postpartum complications.
3. Promote comfort and healing of pelvic, perianal and perineal tissues.
4. Assist in restoration of normal body functions.
5. Increase understanding of physiologic and psychological changes.
6. Facilitate newborn care and self-care by the new mother.
7. Promote the newborn’s successsful integration into the family unit.
8. Support parenting skills and parent-newborn attachment.
9. Provide effective discharge planning, including appropriate referral for home care follow-up.
POST PARTUM ASSESSMENT
(AV BUBBLEHER)

A = Appearance
V = Vital Signs
B = Breasts
U = Uterus
B = Bladder
B = Bowel
L = Lochia
E = Episiotomy/Episiorrhaphy
H = Homan’s sign
E = Emotion
R = Rhogam
Emotional Phases
of Puerperium
 EMOTIONAL PHASES OF PUERPERIUM
1. Taking-in Phase
= woman is passive and dependent
= prefers talking about pregnancy, labor and delivery
= uncertain in caring for newborn
= energies are focused on bodily concerns
= uninterrupted sleep is important
= additional nourishment is necessary
= happens 1-2 days after delivery
2.Taking-hold Phase
= woman begin to initiate action
= interested in taking care of newborn
= asserts independence
= mother focuses on regaining control over her bodily functions –
bowel and bladder; strength and endurance
= happens 2 to 4 days after delivery

3. Letting-go Phase
= gives up old role
= ready for her new role
Post Partum Blues,
Depression &
Psychosis
POSTPARTUM DEPRESSION
* Many mothers experience a “let down” feeling after giving
birth related to the magnitude of the birth experience and
doubts about the ability to cope effectively with the
demands of childbearing.
* This depression is mild and transient, beginning 2 to 3
days after delivery and resolving 1 to 2 weeks
 Common
Postpartum
Complications
 COMMON POST PARTUM COMPLICATIONS

1. Hemorrhage = blood loss more than 500 cc

a. Early post partum hemorrhage

> uterine atony – relaxed or boggy uterus
causes: - large babies
- cesarean birth
- placental accidents
- dystocia

> lacerations - cervix

- vagina
- labia
- perineum

b. Late postpartum hemorrhage

> retained placental fragments
> hematoma
 NURSING INTERVENTIONS

1. Monitor fundus frequently

2. Massage the uterus
3. Apply ice pack in the abdomen
4. Empty the bladder
5. Regulate IVF as ordered
6. Administer oxytocic agents (Oxytocin Maleate)
7. Initiate breastfeeding
8. Monitor VS and watch for indications of hypovolemic shock
9. Prepare and assist for repair of laceration, removal of fragments
or evacuation of hematoma
10. Emotional support
2. Post Partum Infection
a. Infection of the perineum
> pain, heat, feeling of pressure in the perineum,
inflammation,redness, 1-2 sutures slough off, febrile
> remove the suture, drain and resuture
> hot sitz or warm compress
> perilight

b. Endometritis – infection of the lining of the uterus

> abdominal tenderness
> uterine atony
> dark brown foul smelling lochia
> Management: oxytocin and fowler’s position

c. Mastitis
 SOURCES OF INFECTION

1. Endogenous (primary)
= normal flora

2. Exogenous source
= hospital personnel
= excessive obstetric manipulation
= break in aseptic technique
= coitus in late pregnancy
= PROM
3. Thrombophlebitis

> signs and symptoms:

pain, stiffness, redness
swelling
fever and chills
(+) Homan’s sign

> Management
bed rest
elevate affected part
analgesics
anticoagulant

> Avoid:
frequent mobilization
massage
thrombolytic agents
QUESTIONS