Nursing Care of

a Postpartal
Woman and
Family
● The postpartal period, or puerperium (from the Latin puer, for “child,” and
parere, for “to bring forth”), refers to the 6-week period after childbirth.

● It is a time of maternal changes that are both retrogressive (involution of the

uterus and vagina) and progressive (production of milk for lactation,
restoration of the normal menstrual cycle, and beginning of a parenting
role).

● The period is often termed the fourth trimester of pregnancy.

● The physical care a woman receives during the postpartal period can influence
her future health

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 Postpartal period,
or puerperium
(from the latin puer,
for “child” and
parere, for “to bring Video presentation:
https://www.youtube.com/wa
forth”), refers to 6- tch?v=DzVhumIrqd0
week period after
childbirth.
FOR POSTPARTAL WOMAN
AND FAMILY
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 Assess the extent
Assessment of
and quality of the • Health Interview
woman’sof a
Assessment
woman’s interaction • Awareness of her
psychological
woman is
with her child and prenatal, natal, and
adjustment
accomplishedbegins
by
her ability to begin medical history
withtheher reaction to
following: • Physical
infant care and self-
her baby at birth examination
care
• Analysis of
laboratory
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NURSING
DIAGNOSIS
Nursing diagnosis during the postpartal
period are often “risk for” diagnoses and
concerned with a family’s ability to
accept and bond with a new child or with
physiologic considerations. Examples
include:
 ●risk
●●
the
●
riskfor
for
behaviors
coping
“
Health seeking
forcomplications
altered
uncertainity
risk family
regarding
deficient
related
related
human
infant’s
fluid
● fear related to lack of
to
to
in
care
an
well-being
volume related
preparation to if
for child
there of newborn
additional
are
postpartalcare family
lactation/breastfeeding
congenital
hemorrhage
member
anomalies.

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 NURSING CARE
PLANNING BASED
ON 2020
NATIONAL
HEALTH GOALS

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The postpartal period is extremely important
one because of the possibility of uterine
hemorrhage and because it is ithe optimal
period for parent-child bonding. The 2020
National Health Goals that involve this time
period include:
••• Reduce
Increasepostpartum
Reduce the
the proportion
maternaL of
mortality
relapse worksite rate
of smokinglactation
to no
amongsupport
moRe who
women than
11.4/100,000
programs
quit smokingto 38%
live births
from
during afrom
baseline
pregnancy baseline
of 25%.
of 12.7/100,000.
••• Increase
Reduce the
Increase to proportion
the atportion
least 82%
ofofwomen
breastfeed
the proportion
whonewsborns
used of mothers
who recieve
contraception whoto
breastfeed
supplemental
plan theirformula
babies in the first
their pregnancy. early2 postpartum
days from 24%periodto 14%.
from a
• baseline
Increaseofthe74%
proportion
and increase
of livethe
births
proportion
that occur
of mothers
in fascilities
who
still
that breastfeed
provides careat for
6 months
lactatingtomothers
60.6% and from
thera babies
baseline
fromof
43.5%.
2.9% to 8.1%.
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 OUTCOME
IDENTIFICATIO
N AND
PLANNING
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Be certain that outcomes establish during this time are realistic in light of woman’s
changed life pattern, support from family, and cultural preferences. Most postpartal
families remain in the hospital for relatively short time, only 48 to 72 hours. That
means outcomes must be devised that can be accomplished and evaluated during
this period of patient contact. If an outcome cannot be evaluated within this short
time frame, follow-up home care, ambulatory visits, or phone calls may be
necessary
When planning care in the postpartal period, try to arrange problems procedures to allow
optimal time for family-infant interaction and yet provide adequate time for a woman to
rest to prevent exhaustion because this can improve her coping ability and plans for self-
care.
Nurses can become active in promoting and incorporating the Ten Steps for a Baby-
Friendly Initiative strategies (BOX 17.2) postpartum to promote breastfeeding and
infant-maternal bonding such as immediate skin to skin contact after birth

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U.S Baby Friendly Hospital Initiative Baby-
Friendly Ten Steps:
● Give newborn
Have a written infants
breastfeeding
no foodpolicy
or drink
thatother
is routinely
than breast-milk,
communicated
unless medically toindicated.
all health care staff
● Practice
Train all “rooming
health carein”
staffs
– allow
in the
mothers
skills necessary
and infants
toto
implement
remain
this policy
together 24 hours a day Box 17.2
● Encourage
Inform all pregnant
breastfeeding
women on about
demandthe benefits and management of
● breastfeeding
Give no pacifiers or artificial nipples to breastfeeding infants
●
● Help
Fostermothers initiate breastfeeding
the establishment withinsupport
of breastfeeding one hour of birth
groups and refer
● Show mothers
mothers to themhow
on to
discharge
breastfeed
from
and
thehow
hospital
to maintain
or birthlactation,
center
even they are separated from their infants.
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After adequate instruction and assurance that mom and baby
are healthy, a woman should be prepared to monitor her own
health after she returns home.

Planning should also include ample time for health teaching

such as care of the newborn and the need for flexibility in
care because the parents do not yet know what their new life
will be like or how tired they will become after being
awakened frequently during the night.

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IMPLEMENTATIO
OUTCOME
N
EVALUATION
• The parents spontaneously verbalize at least one positive comment
Evaluation
All interventions
in the post
in thepartal
postpartal
period, period
then,should
involves benot
family
only
about their child’s characteristics before hospital discharge.
being
•centered,
The certain
to state
patient enhance
a woman family
and her
she believes functioning
she baby
will beare
ableand
safe bonding,
but also
to manage and
that
newborn
the care
woman
geared knows
toward
with the supporthow
increasing
to maintain
of her a woman’s
significant her ownself-esteem,
other. and her infant’s
•allowing
health.
The herSuch
patient’sto view
follow
lochial herself
flow upnoevaluation
is as a than
more newsaturated
mother
can be done
and helping
bypad (50
perineal
ml) every
telephone, 3 hours.
her view
during herhome
new infant
visits, aoras
during
part ofpostpartal
her family.
and well
• The patient states she is tired but feels able to manage her newborn
child assements. Examples of expected outcomes include:
and family care.
• Physical interaction and holding of the infant appears appropriate and
responsive to the infants need.
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 The postpartum period is a time of transition, during
which a couple gives up concepts such as “childless”
Psychological or “parents of one” and moves to not only trying out
changes of the their new role but also determining whether they “fit”
Postpartal their new role. Nurses can help couples acknowledge
Period the extent of the change so that they can gain closure
on their previous lifestyle. Opening channels for
communication, anticipating new needs, and
highlighting potential gains that will occur because of
the change are important actions.

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 BEHAVIORAL
ADJUSTMENT:
PHASES OF THE
PUERPERIUM 15
In the classic work on maternal behavior,
REVA RUBIN, a nurse, divided the
puerperium into three separate phases;

TAKING-IN
TAKING-HOLD
LETTING-GO
PHASE
PHASE 16
●Encouraging
The taking-in
her phase
to talk is largely
about a time
the birth is of
an
reflection.
important way to help her integrate the
●experience into1-her
During this to total
3-daylife experiences.
period, a woman is
largely passive.
TAKING -IN
●Encourage
She prefers
the having
mother atonurse attend
express to her
her feelings PHASE
regarding
needs andthemake
difference from for
decisions the her
anticipated
rather than
birth plan. Being
do these thingsable to acknowledge and
herself.
articulate her feelings that her preconceived
● The woman usually wants to talk about her
birth plan did not occur as intended is a
pregnancy,
healthy way toespecially
release anyabout her labor
negative and
emotions.
birth.
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• A
She often begins
woman still feels insecureaction.
to initiate about She
her ability
prefers
to get
careher
forown
her new child. or
washcloth Shetoneeds
make praise
her ownfor
the things she does well to give her confidence.
decisions.
• Women
Do not rush
whoagive
womanbirththrough
withoutthe
anyphase of
anesthesia
taking-in
may reachorthis
prevent
secondherphase
fromintaking holdofwhen
a matter TAKING-HOL
she reaches
hours this point.
after birth.
• A
First-time mothers
woman begins tomay
takeneed additional
a stronger interest in PHASE
guidance
her infant and
and time during
begins this phase.
maternal role behaviors.

As a rule, it is usually best to give a woman a brief

demonstration of baby care and then allow her to care for her
child herself with watchful guidance as she enters this phase.
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• In this third phase, a woman finally redefines
her new role. She gives up the fantasized
image of her child and accepts the real one; she
gives up her old role of being childless or the
mother of only one or two. LETTING-GO
• This process requires some grief work and
readjustment of relationships, similar to what PHASE
occurred during pregnancy. It is extended and
continues during the child’s growing years.
• A woman who has reached this pase is well
into her new role.

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DEVELOPMEN
TAL OF
PARENTAL
ATTACHMENT,
BONDING, AND
POSITIVE
FAMILY
RELATIONSHI
P
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 ● When a women has successfully linked with her newborn, it is
●
● Gradually,
Often termed as aengrossment,
wooman holds heraction
this childalerts
more,caregivers
she beginstotohow
termed attachment or bonding. Although a woman carried the
express
actively more warmth,
the fathers, as touching
well as the themother,
child with the palm bonding.
is beginning of her
child inside her for 9 months, she often approaches her newborn
hand rather than with her fingertips.
● whennot pregnancy
as someoneorshe newborn
loves butcomplication
more as shelead to separation
would approach aof
● She smoothes’
thestranger.
mother fromtheherbaby’s hair, itbrushes
newborn, places athe
cheek,
woman plays with toes,
at greater
and
risk lets
for the baby’s fimgers
developing clasp hers.
posttraumatic stress disorder and interferes
● The first time she holds the infant, she may touch only the
● with
Soon, usual process of bonding.
she feels
blanket. If shecomfortable
unfolds theenough
blanketto topress her cheek
examine the babyagainst
or count
thethe
baby’s or or
fingers kisstoes,
the she
infant’s
may nose;
use onlyshe her
has fingertips
successfully
for bonded
touch.
or become a mother tending to her child.
● Skin-to-skin contact soon after birth facilities the early
● Looking directly at her newborn’s face, with contact (termed an
attachment and binding phase. This should ideally occur within
enthe
face position),
first hour of anyis a sign
birth,a even
woman is beginning
cesarean effective
deliveries, as soon as
attachment.
mother and direct
babyeyeare stable and last until completion of the first
● Many fathers can be observed staring at a newborn for long
breastfeeding.
intervals in this same wayl.
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Rooming-in occurs when the infant remains in Rooming-
the woman’s room and the mother and child are
together 23 out of 24 hours a day.With both
complete and partial rooming-in (infants spends
In
time in newborn nursery), the father and
siblings can hold the infant when they visit. In
many settings, the father can stay overnight in
the mother’s room.

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24 hour
24 hour Rooming-In
Rooming-In benefits
benefits for
for baby:
mother:
● Better quality
quality sleep
sleep. Your baby will develop a more regular sleep-wake cycle earlier,
● and may help
Increased ease theintransition
confidence handlingtoand
day/night routines
caring for baby
● More
Abilitystable bodywhat
to learn temperatures
your baby’s cues are (sleepy, stressed, in need of quiet time, or
● hungry)
Generally more content, less crying
● Earlier identification
More stable blood sugarof early feeding cues (rooting, opening mouth, and sucking on
● tongue, fingers, or hand)
Breastfeed sooner, longer, and more easily
● Improved breastfeeding experience
● Lower levels of stress hormones
● Less infant crying and distress (they love to be near you)
● Babies exposed to normal bacteria on mother’s skin, which may protect them from
● Less “babysick
becoming blues”
dueand postpartum
to harmful depression
germs.
● Parents are better-rested and more relaxed by the end of the first week home.
● Increases opportunity for skin-to-skin contact

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SIBLING
VISITATIO
N

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• Separation from children is often as painful for a
mother as it is for her children.
• A chance to visit the hospital and see the new baby and
their mother reduces feelings that their mother cares
more about the new baby than about them.
• The visit can relieve some of the impact of separation
and also help to make the baby a part of the family.
• Assess to be certain siblings are free of contagious
diseases such as upper respiratory tract illnesses or
recent exposure to chickenpox before they visit.Then,
have them wash their hands and if they choose, hold or
touch the newborn with parental assistance.
• Encourage the success of a family visit by evaluating if
the mother would like to take her pain medication
before the visit.

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MATERNAL CONCERNS AND FEELINGS IN THE
POSTPARTAL PERIOD
Traditionally, it is assumed the bulk of a woman’s concerns in the the postpartal period
center on care of her new infant.As result, classes in the postpartal period have
traditionally focused on teaching how to breastfeed and bathe infants.Many women,
however, are not as concerned about infant care as they are about their adjustment to a
new role change.

Typical issues identified by postpartal women that they would like to her discussed are
breast soreness; regaining their figure;regulating the demands of a job, housework, their
partner, and their children; coping with with emotional tension and sibling jealousy; and
how to combat fatigue.

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Abandonment
Many mothers, if given the opportunity, admit to feeling abandoned and less important after giving birth than they did
during pregnancy or labor. Only hours before,after all She have the center of attention, with everyone asking about
her health and well-being.

Now, suddenly, the baby is everyone's chief interest. Relatives ask about the baby's health; the gifts are all for the
baby.

Even a woman's primary health- care provider

we can help a woman move past these feelings by verbalizing the problem: “How things have changed! Everyone's
asking about the baby today and not about you, aren't they?" These are reassuring words for a woman and help her
realize that, al- though uncomfortable, the feeling she is experiencing is normal.

When a newborn comes home, a father or partner may express much the same feelings as he or she feels resentful of
the time the mother spends with the infant.

Examination of these competitive feelings can help a couple realize that parenthood involves some compromise in
favor of the baby's interests. Making infant care a shared responsibility can help alleviate these feelings and make
both partners feel equally involved in the baby's care. You can help parents or partners move past this competitive
stage by pointing out positive parenting behaviors, positive self-care behaviors, and the warm infant response to their
behaviors
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Disappoinment
Another common feeling parents or partners may experience is disappointment in the baby. All during
pregnancy, they pictured a chubby-cheeked, curly-haired, smiling girl or boy.
 
They may have instead a thinner baby, without any hair, who seems to cry constantly, or may have a
congenital condition.This can make it difficult to feel positive immediately toward
a child who does not meet their expectations.
It can cause parents to remember their adolescence, when they felt gangly
and unattractive, or to experience feelings of inadequacy over again.
 
As a nurse to tip a scale toward acceptance or ar least help a person involved to take a clearer look at
his or her situation and begin to cope with the new circumstances. As an example,
handle the child warmly, to find the infant satisfactory or even special. Comment on the child's good
points, such as long fingers, lovely eyes, and healthy appetite.

Be aware, however, that, culturally, some groups are fearful for the baby if these types of comments are
made because they could draw evil influences toward the child.

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 NURSING
CARE
PLANNING
TIPS
Page 399

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Leonora Cooper gave birth to a boy 6 hours ago, you want to
assess her for postpartal pain, so you enter her hospital room.
She is wearing a hospital gown and sitting in a chair by her bed.

• Use therapeutic communication that encourages women to

elaborate on their story
• Avoid any communication that discourages story telling
• Repeating the story of how worried they were when labor
started, how much pain they had, or how scared they were
when their membranes broke helps them put these sensations
into perspective and integrate them into their life experiences

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POSTPARTAL
BLUES
Page 402

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POSTPARTAL OR Baby blues is a feeling of sadness or moodiness that many women
experience after giving birth.

During the postpartal period, as many as 50% of women experience some feelings of
overwhelming sadness or “baby blues” (Baselice & LAwson, 2012). This phenomenon
may be caused by hormonal changes, particularly the decrease in estrogen and
progesterone that occurred with delivery of the placenta. Breastfeeding has been
shown to help elevate baby blues and counteract the effects of hormonal drops that
occurs after childbirth. For some women, it may be a response to dependence and low
self-esteem caused by exhaustion, being away from home, physical discomfort, and the
tension engendered by assuming a new role, especially if a woman is not receiving
support from her partner. In addition to crying, the syndrome is evidenced by feelings
of inadequacy, mood lability, anorexia, and disturbance.

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