NURSING CARE FOR

POSTPARTUM
MOTHER
Group 1
 Member of group 1 :

Alif Sachrul Minsaid (I1J020006)

Faratina Onisoa Anthony (I1J020007)
Fuzna Dahlia Mudzakiroh (I1J020010)
Jonathan Puji Hadisasono (I1J020009)
Livia Putri Adisti (I1J020008)
Background
After giving birth, mothers face quite serious problems, namely caring
for babies and recovering their physical and mental conditions
because after giving birth (post-delivery) mothers experience
changes, both physical changes and reproductive organs, as well as
psychological changes (Huliana, 2003). The puerperium (puerperium)
is a period of recovery, starting from the completion of labor until the
uterine equipment returns such as pre-pregnancy, this postpartum
period is 6-8 weeks (Prawirohardjo, 2015).
Afterpains is pain or cramping in the area around the abdomen that
occurs 2-3 days postpartum caused by the return of the muscles and
organs of pregnancy which is the process of uterine involution, the
mother will feel pain or cramps in the area around the abdomen. This
pain is called afterpains. This pain will last for 2-3 days after delivery
(Gani, 2008). Pain can be felt at various levels ranging from mild to
moderate pain to severe pain. The level of pain felt by post-partum
patients depends on the many sources of pain, the patient's tolerance for
pain, and psychological and environmental factors (Carpenito, 2000;
Potter and Perry, 2006; Bobak, 2005; Rohmah. N. & Walid, S. 2008) ).
Purpose
 General Purpose
This report aims to provide knowledge about afterpains and an overview of nursing
care in Ny. Nita who is a postpartum mother.
 Spesific Purpose
 Assess the mother with afterpains after postpartum.
 Establish nursing diagnoses in mothers with afterpains after postpartum.
 Develop nursing plans for postpartum mothers with afterpains.
 Perform nursing interventions according to the nursing plan for postpartum mothers
with afterpains.
 Evaluating nursing actions in postpartum mothers with afterpains.
 Knowing the signs and symptoms and afterpains factors in postpartum mothers.
 This study aims to determine the complications and consequences of afterpains in
postpartum mothers.
 To know the relationship of afterpains in postpartum mothers with breastfeeding
barriers and multiparous mothers with twins.
Case Overview
Case 1: Askep Post-partum
Mrs. Nita, a multipara, gave birth to twins vaginally 4 hours ago. The baby weighs 3
and 2.5 kg. Mrs. Nita is being treated in the inpatient unit. The results of the initial
assessment obtained data: blood pressure 110/70 mmHg, pulse 60 x/minute,
breathing 20x/minute, temperature 37.60C, fundus slightly boggy and palpated to the
right of the umbilicus, moderate lochia, midline episiotomy, intact with slight edema.
Mrs. Nita plans to exclusively breastfeed her baby, previously the client successfully
breastfed her two children for 2 years each, but the client said that her stomach felt
very painful every time she breastfed and a lot of blood came out, and felt that she
had never experienced anything like that when breastfeeding her two children before.
Mrs. Nita is also worried about her bowel movements, because in previous deliveries
she had problems, and the client also experienced constipation at 9 months of
pregnancy.
Discussion

1.What is your interpretation of the results of the initial assessment in the above case?

Referring to the most visible symptom experienced by the patient, the client
experienced a very painful stomach every time she breastfed and bleeding
profusely, whereas previously the client had never experienced anything like this
when breastfeeding her two children before. This is also a multiparous birth with
twins. Previously, at the age of 9 months, the client said that he was constipated.
So if arranged based on the symptoms of these symptoms, the client experiences
afterpains (contraction of the uterus / uterus to return to a normal state).
 What initial action should be taken immediately based on the findings in the
initial assessment?

Afterpains is painful contractions of the uterus that occur for several days
after delivery; they occur most often in multiparas and are more painful
during breastfeeding (Leifer, Gloria., 2019). So, the initial action that must be
taken based on the assessment is to determine what actually happened to
the client. If it does lead to afterpain with painful symptoms, then the patient
must be treated immediately to reduce the pain so that the process of
mobilizing and breastfeeding the baby smoothly.

For the above case, we should identify pain in the woman's mother, after
that we educate about the disease experienced by the patient and continue
by providing priority care to support patient mobilization. make patients less
anxious about their health and encourage them.
3.What conditions does the client experience when breastfeeding her baby and
feels pain in her stomach? Why did you not feel this condition when
breastfeeding your child before?

Uterine involution or uterine contraction is a process by which the uterus returns to its
pre-pregnancy state. Uterine involution can also be said as the process of returning the
uterus to its original state or pre-pregnancy state (Bahiyatun, 2013). Existing
contractions cause pain (afterpain), especially in multiparas. Afterpain is pain (cramps
and heartburn) that can be caused by uterine contractions. This lasts for 3-10 days
postpartum and is common in multiparas, because a fully distended uterus is twice as
likely to sag as a primiparous uterus and must therefore contract more forcefully to
produce uterine involution. Afterpain occurs when mothers breastfeed because milk
production causes the release of oxytocin which stimulates the uterus to contract
(Mander, 2013).
The theory that supports the researcher's analysis was put forward by Olds et al (2000), who
said that afterpain occurred more frequently in multiparas than in primiparas which was
associated with a tendency for the multiparous uterus to relax. Olds et al's estimates are
supported by a survey in Scotland that included uterine cramping in data collection that fewer
primigravida women had this pain and it was more severe in multiparous women. The incidence
and level of pain was when afterpain was perceived as moderate/severe by 56% of multiparous
women on the first day (Dewan et al., 1993).
 4. What nursing problems does the client experience? What data support your answer?

Afterpain causes psychological problems (such as depression, anxiety, anorexia,

insomnia) and makes the mother unable to carry out her daily routine. During the
breastfeeding period, neurohormonal stress caused by pain reduces the mother's desire
to breastfeed, reduces her interest in the newborn, weakens attachment and bonding
processes, and affects milk secretion. For a mother who cannot breastfeed her baby,
the likelihood of mood swings such as guilt, anxiety and sadness increases. This will
also have an impact on the baby. Babies can be at risk of malnutrition and falling ill if
the mother does not breastfeed. This change in lactation is a response to the action of
prolactin secreted by the anterior pituitary gland (Brayshaw, 2008). Pain can also make
the bonding attachment between mother and baby delayed (bonding attachment) due
to the condition of one of the mothers or babies being sick (Suherni et al, 2008).
 5. What is the most priority nursing problem? Justify your answer!

Priority needs that must be met is pain. Some of the basic considerations
used to determine pain as a priority include comfort as a basic physiological
need, good fulfillment can not only reduce, reduce, or eliminate pain, but also
increase early mobilization, help clients work earlier, shorten hospitalization
period. , and reduce treatment costs, pain that cannot be overcome or
controlled in postpartum mothers can cause fatigue, anxiety and worsening
pain perception, so that early mobilization is hampered, lactation is inhibited,
the attachment bonding process is inhibited, disappointed because of
discomfort, disturbed sleep patterns, and even prolonged pain increases the
risk of post-partum blues (Hamilton 1998: Carpenito, 2000; Bobak 2005;
Potter and Perry, 2006; Rocmat, 2008).
What are the goals and nursing action plans that you formulated to address the
client's priority problems?

The nursing action plan to be carried out is to conduct a comprehensive and rational pain assessment
to determine the scale, pain scale, intensity, area of ​pain, and time of pain. Pain that makes post-
partum mothers uncomfortable is a serious problem that must be immediately addressed by health
workers. As health workers, nurses have a major role in overcoming problems like this. Nurses must
act quickly in order to increase the comfort of postpartum mothers. These actions can be in the form
of medical actions in the form of pharmaceutical therapy or non-pharmaceutical actions such as cold
compresses, breathing exercises, massage, relaxation and postpartum gymnastics (Herlina, 2003).
These actions can be in the form of pharmacological measures: by giving analgesic drugs, and non-
pharmacological measures such as assessing pain, emptying the bladder, providing a comfortable
position: prone position by giving a pillow under the stomach, relaxation techniques by practicing
deep breathing, distraction techniques by remembering God Almighty. Esa, informing the cause of
pain, the importance of mobilization, increasing rest, counseling on balanced nutrition, and
postpartum gymnastics.
7.Choose a topic from the nursing action plan made, and discuss the
content to be written in the poster/leaflet.
Nursing Care Plan
Post partum pain intervention can be done through warm compresses,
distraction, guided imagination, therapeutic touch or massage,
interaction with babies (Hamilton, 1998: Carpenito, 2000; Bobak, 2005;
Potter and Perry, 2006; Rocmat, 2008)
Nursing Implementation
Implementation in accordance with the plans that have been prepared. The
implementation of postpartum exercise is not in accordance with the action plan on the
first day, but will be carried out on the second day because the first day in the taking-in
phase, the patient is still focused on himself, feels tired, and feels weak. It is not
appropriate to provide counseling and postpartum exercise, this is in accordance with
Rubin's theory. So that this action will be carried out on the second day and will also be
carried out on the third day at the client's house, because the nurse takes the client's
spontaneous postpartum mother so that she is hospitalized for only 2 days, then
nursing actions will be carried out at the client's home.
Evaluation
Evaluation on the third day the client said that afterpains pain was reduced by a scale of 4. The
objective data of the client seemed relaxed, could sleep comfortably. The analysis of both clients
was achieved, according to the expected outcome criteria on a pain scale of 1-5, the patient
seemed relaxed, the patient could sleep comfortably, vital signs (temperature, pulse, blood
pressure, and frequency) were within normal limits. This is in accordance with the theory put
forward by M. Judha, et al. (2012).
Nursing Documentation
Documentation is an activity to record all actions that have been taken.
Nursing documentation is very important to do because it is useful for
avoiding overlapping events, providing incomplete information on
nursing care, and fostering coordination between colleagues or other
parties.
 Conclusion

From the data obtained from the case, the conclusion of continuous nursing care for Ny. Nita, after
giving birth 4 hours post-partum with complaints of afterpains caused by uterine contractions that
cause pain, causing discomfort to the mother, the efforts that can be done by the mother are to do cold
compresses on the painful part, teach relaxation techniques, and breathing exercises. The discomfort
felt by the mother is a natural thing experienced by postpartum mothers as long as it is not
accompanied by pain in the epigastrium, diastasis recti, subinvolution, no edema in the face and
extremities, the face is not pale, and the conjunctiva is pink. Mothers have been given health education
on how to overcome perceived complaints, including massage on the uterus, relaxation, given cold
compresses, and regulating breathing in accordance with the results of observations that the pain felt
by the mother has been somewhat reduced by regulating breathing and cold compresses. Likewise, his
anxiety can be reduced if the pain can be overcome.
Suggestion
Nurses can provide more guidance to
postpartum mothers to carry out pain
management and provide information on the
causes and effects of pain felt by the client.
Able to teach patients about postnatal care
and adaptation.
Thanks!
REFERENCES

Bulechek, G.M., Butcher, H.K., Dochterman, J.M., & Wagner, C.M. (2016). Nursing Interventions
Classification (NIC), Edisi 6. Philadelpia: Elsevier.

Evcili, Funda., & Didem Kaya. (2019). “The effect of Postpartum Afterpain on Breastfeeding Self-
Eficacy”, Cukurova Medical Journal, Vol. 44, No. 1: 296-307. DOI: 10.17826/cumj.559442.

Gilbert J, Grant., Agoliati, Andrew P., Echevarria, Ghislaine C., & Lax, Jerome. (2019). “Epidural
Analgesia to Facilitate Breastfeeding in a Grand Multipara”, Journal of Human Lactation, Vol. 35,
No. 1: 165-167.

Harnany, Afiyah Sri., Hartati., Inayah., etc. (2021). “Pengelolaan Keperawatan Nyeri Ibu Nifas
dengan Afterpains pada Ny. Rs dan Ny. Rn di Ruang Lily RSUD Kabupaten Batang”, Jurnal Lintas
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