POSTPARTUM CARE

Postpartal >> Siti Handayani

• Postpartum Period (Puerperium / Nifas)
Is the interval (lasting 6 weeks) from child
birth. Puerperium = fourth trimester.
Divides into :
# immediate pp (first 24 hours)
# early pp (first week)
# Late pp
• Main goals :
To assist and support the woman recovery to
the prepregnant state.
Assess and identify deviation from to norm,
and
Educate the mother about her own self care
and infant care.
 Maternal Physiologic changes
1. Involution of the uterus (1000 gr  60 gr)
• Exfoliation ( a unique healing processthe placental
site to heal without scarring  most important
aspects of involution = 6 weeks.
• Endometrial regeneration = 3 weeks.
• Descent of the uterine fundus :
after birth (12 hours)  umbilicus.
average : 1 cm / day.
no palpable abdominally by day 10.
Afterpains ( multiparas, breastfeeding )
 TABLE 1. Factors That Retard Uterine
Involution
Factors Rationale

Prolonged labor Muscles relax due to prolonged

time of contraction during labor.
Anasthesia Muscles relax.
Difficult birth The uterus is manipulated
excessively.
Grandmultiparity Repeated distension of uterus
during pregnancy and labor leads
to muscles stretching, diminished
tone, and muscles relaxtation.
Incompelete The presence of even small
expulsion of amount of tissue interferrse with
placenta and/or ability of uterus to remain family
membranes. contracted.
Infections. Imflammation interferres with
uterus muscle’s ability to
contract effectively.
 Lochia :
• rubra = the first 3 days
• serosa = 4 - 9 days.
• alba = 10 – 20 days (3 weeks)
• Total volume = 240 – 270 ml.
After pains : multiparas > primiparas (2 – 3
days), caused by intermittens uterine
contraction.
 Cervix, vaginal, and perineal
• Cervix is spongy, flabby, and formless and may
appear bruised.
• Vagina edema + bruised, laceration, rugae 
return by 3 weeks.
• Perineum = edema, bruised, ruptur / epis.
2. Urinary System
• The bladder fills rapidly because of the
diuresis that follows childbirth  the mother
is at risk for overdistention of the bladder,
incomplete emptying of the bladder and
retention of residual urine  UTI (urinary
stasis allows time for bacteria to multiply) +
risk of postpartum hemorrhage ( uterine
atony).
• Signs of a distended bladder:
• Locations of fundus above baseline level (bladder is
empty)
• Fundus displaced from midline
• Excessive lochia
• Bladder discomfort
• Bulge of bladder above symphisis
• Frequent voidings of less than 150 ml of urine
(indicates urinary retention)
3. Circulatory System.
• Pregnancy  hypervolemia (Inc. blood
volume ± 50%).
• Excess blood volume  disposed in two ways
: by diuresis  2000 – 3000 ml/day and by
diaphoresis.
 Vital Signs :
• Temperature : The first 24 hours, increase 100.4° F 
dehidration + exertion labor.
• > 24 hours, temp ≥ 38° C, infection?
• Blood pressure :
stable
decrease  excessive blood loss.
increase  PIH (especially + headache)
pulse = bradycardi 50 – 70 bpm (first week)
elevated  blood loss, infection, pain,
cardiac disease.
4. Gastrointestinal System
• Hungry + thirsty
• Constipation > 3 days
• Haemorhoid.
5. Abdominal wall
• Return 6 weeks.
• RDA (DRA)  diastasis rectus abdominis (separated),
over distension (twin, large baby)
• Weight loss(Cunningham et al,1997):
• Immediate weihgt loss (12-13 lbs)
• 2 weeks postpartum (+ 8-9 lbs)
• 6 months to return to their prepregnant
weight.
• Endocrine system:
• Lactation (2-3 days after birth)
• Menstrual cycle ( Bowes, 1996 ):
=Nonbreastfeeding mothers, prolactin level
returns to the prepregnant level within 2 weeks,
> ovulation (27 days-2 months).The return of
menstruations > 3 months.
= Breastfeeding mothers; the average time for
ovulation (190 days).
25% > ovulates before their menstrual periods
return ( Zlatnik, 1999 ).
• Maternal Psychosocial Changes
• Rubin (1961): takes place in three phases
a. “Taking-in phase” /Dependent = 2-3 days
Mother’s passive and dependent,
Mother need to talk about labor and delivery experience to
integrate them into fabric of her life.
Mother may need help with everyday activities, as well as
child care
Food, fluid and sleep (focus)
Studies by Ament (1990) and Wrasper (1996)  taking-in
phase = 24 hours after birth.
b“Taking-Hold”/Dependent-independent
=The mother more independent,
interest+responsibility (her self care, infant
care)  Health education!!!
= Some emotional lability, may cry” for no
reason “
= Mother requires reassurance that she can
perform tasks of motherhood.
c.”Letting-Go”/Independent=5-6weeks.
Reestablishment of father-mother bond.
They must let go of their expectations and
accept the reality of their infant.
Mother may still feel tired+overwhelmed
by responsibility and conflicting demands on
her time and energies.
• Family Adaptation:
• Family roles and relationship must be reorganized with the
birth of a baby.
• Bonding and Attachment
• Bonding = rapid process of attachment, parent to child only,
(sensitive periode = 30 – 60 minute after the birth.
• Attachment, a long-term process that begins during
pregnancy and intensifies during the postpartum periode.
• Methods; touching, exploring, talking to, and eye contact.
 Family Adaptation
Siblings’ Adaptation to Neonate
• Respons ? Depends on age and
developmental level of the older sibling,
exp.Toddler  probably most difficult 
• competition  negative behavioral changes.
 Factors Affecting Family Adaptation
• Parental fatique
• Previous experience with a newborn
• Parental expectations of the newborn
• Knowledge of and confidence in providing for
newborn needs
• Temperament of the newborn
• Temperament of parents
• Age of parents
• Available support system
• Unexpected events; cesarean birth, infection.