Postpartum after Delivery

Postpartum is the period of time after the birth of a baby when the body is changing back to normal. It lasts about 6 weeks or until the uterus returns to its normal size. The postpartum period is a time of unrivaled demands and unique stresses, and is a developmentally challenging time for new parents even in the best of circumstances. During a normal postpartum experience, it is not unusual for new parents to experience heightened family and family-of-origin issues associated with the transition to parenthood. For example, adjustments usually need to be made in areas such as sleep schedules, employment, and role allocation. And, even for seasoned parents, there is the adventure of understanding the particular infant's unique temperament, needs, vulnerabilities, and strengths. The experience of depression in the mother during the postpartum period transforms an already challenging adventure into a potentially overwhelming one.

SIGNS AND SYMPTOMS: Fever an increase in temperature is a sign of infection or inflammation. This may occur in the breast, uterus, bladder, or vaginal-perineal area if stitches were required. Urinary Problems after giving birth, a woman has a higher chance of developing an infection in the bladder or urinary tract. Symptoms may include increased urinary frequency, burning with urination, smelly urination, low pelvic pain on urination, and low backache. Perineal Pain and Swelling Perineal discomfort or swelling is common following delivery but should gradually lessen over the first few days. The pain will feel like a bruise when touched. If it is more painful than that after five days, or if the area around the stitches is red and swollen, this may be a sign of infection and the doctor or midwife should be contacted. Increased Vaginal Bleeding If at any time blood clots larger than a plum are passed or bleeding becomes bright red again with an unpleasant odor, this is abnormal.

Unpleasant Vaginal Odor Vaginal discharge has its own odor but should not be unpleasant. An unpleasant odor could be a sign of uterine, cervical, or vaginal infection. Breast Infection An infection in the breast tissue is called mastitis. Signs of mastitis include fever, breast pain that becomes worse as the baby nurses, or redness and possible lumps in the breast.

Pain and Tenderness in the Legs Blood clots in leg veins after delivery are common but abnormal. Signs include fever, leg pain, and/or a hot, red area on the leg and pain in the calf when stretching the legs. Immediate treatment is necessary Hemorrhoids Hemorrhoids are varicose veins in the rectum. They feel like tender, swollen lumps that may itch or hurt. Hemorrhoids during pregnancy are caused by three factors: hormonal changes relaxing the walls of blood vessels, pressure from the extra weight of the unborn baby, and the strain of pushing during the birth. After the birth, hemorrhoids should shrink over time and usually disappear within a few weeks. To relieve some of the discomfort, medicated pads such as Tucks pads may be applied or use a sitz bath

Medications

Health teaching

Rest: You need rest. However, with caring for and feeding a new baby, there is not much time to rest. You can get help from friends and family and have extra time to care for the baby and yourself. Because you must feed the baby day and night, you may need to change your sleeping schedule to get enough rest. Try to sleep while the baby sleeps. Morning and afternoon naps can be very helpful. Pain relief: If you delivered the baby normally through the birth canal, pain in the area between the rectum and vagina is common. To relieve the pain and prevent infection, you can sit in a warm bath, put cold packs on the area, or put warm water on the area with a squirt bottle or sponge. It is also important to wipe yourself from the front to back after a bowel movement to prevent infection.

Proper diet

Maintaining a well balanced diet remains important. Keep taking your prenatal vitamins. If you are breastfeeding, they need to be continued until you are done breastfeeding. Breastfeeding also increases the need for water, calories and calcium. Caloric intake needs to be increased by 1000-1500 calories per day. This can be done by adding two dairy servings, one protein, and one vegetable per day. You should try to drink 6-8 glasses of water per day.

Nursing intervention

Independent:
Monitor amount of bleeding by weighing all pads. Frequently monitor vital signs. Massage the uterus. Place the mother in Trendelenberg position. Provide comfort measure like back rubs, deep breathing. Instruct in relaxation Or visualization exercises.Provide diversional activities.

Collaborative:
Administer oxygen as indicated. Administer medication as indicated (e.g Pitocin, Methergin)

Nursing diagnosis

descriptive, correlational study was undertaken to identify nursing diagnoses selected by mothers during the first 72 hours after birth. The convenience sample of 231 women completed questionnaires listing 34 diagnoses. On average, each mother selected nine diagnoses of concern to her since the birth. Alteration in comfort, potential for growth, alteration in body fluids, impaired mobility, and sleep pattern disturbance were the most frequently selected diagnoses. Only 34.5% of the mothers identified knowledge deficit as a concern. Parity, type of delivery, and length of postpartum time influenced the diagnoses selected. The data suggest modifications in the focus of hospital-based, postpartum nursing care.

Laboratory test:

A CBC (complete blood count) is the primary among postpartum lab tests ordered following childbirth. It would be expected that the white blood cell count would increase temporarily due to the stress of giving birth and that the hemoglobin and hematocrit would decrease.

The hemoglobin is a measurement of the oxygen transport mechanism of red blood cells. The portion of the hemoglobin molecule that can bind to oxygen includes iron, so the capacity to transport oxygen is dependent on the blood iron levels. Normal hemoglobin levels for an adult woman is 12-16 gr/dl.