3 Post Partum Adaptations Flashcards
Postpartum is classified as what
Puerperium?
Postpartum: birth to return of the reproductive organs to their non pregnant state (approximately 6 wks)
Puerperium: 4 trimesters
Uterus
What we want: involution
What we dont: subinvolution
Involution:
Return of uterus to nonpregnant state
-firm/midline
-By 12 hrs 1 cm above or ate umbilicus
-descends 1-2cm q24hrs
Subinvolution:
Failure of the uterus to return to nonpreg state
Contactions:
Ways we get oxytocin
Afterpains
Oxytocin: hormone(breast stimulation) vs exogenous(iv)
After pains: periodic relaxation and vigorous contractions
-intense cramps
-common in multiparous
-Overdistention (macrosomia, multifetal, polyhydramnios)
(Uterus gets big and has to work hard to return to normal)
Assesssment of lochia
Post birth uterine discharge 4-6wks
Rubra: 1-3 days (bright red)
Serosa (4-10 days) pink
Alba 10days - 3wks, can last 3-6wks (white)
Assessment of cervix, vagina, and perieum
Episotomy and laceration assessments
Hemorrhoids
Pelvic muscular support
Kegel exercises
Breast feeding mothers
What for the 1st 24hrs
Transitions to what by when
How to tx engogement
Colostrum for 1st 24hrs
Transition to milk in 72-96 hours
Engorgement tx:
-Cold compress, warm compress/showers, cabbage leaves
-Pain meds
-increased feedings 8-12 per 24hrs
-pump to comfort
Non breastfeddin mothers
Engorged when
Resolves how and when
Tx
Engorged 3-4th day
Resolves spantaneouly and decreased within 24-36hrs
Tx:
-icepack
-painrelievers
-supportive bra
(NO STIMULATION)
Effects on mom:
Cardiovascular
Blood loss (vag=500, c/s=500-1000)
Cardiac output
VS (temp to stay under 100.4)
Varicosities
Blood components:
⬆️WBCs
⬆️coagulation (worried about thrombin event)
HGB and HCT
Effects on mom:
Respiratory
Decreased pressure on diaphragm
Breath sounds clear
Sudden chest pain & resp distress (PE/AFE????)
Effects on mom:
Endocrine
Prolactin remains elevated for mothers breastfeeding
Menstruation returns 7-12wks non-lactating
Menstruation 3mos-1yr lactating
Effects on mom:
Fluids/urinary
Fluid loss:
-Diuresis: 3000ml/day for 2-3days
-Wt loss of 5-6lbs
Urethra and bladder:
-Decrease urge to void
-Freq voiding of 150ml or less
-excessive bleeding if bladder is distended
Effects on mom:
GI
S/s
Tx
Increased appetite
Fear of bowel movement
Constipation
Hemorrhoid
Tx:
Stool softener
Teach prevention of constipation
Effects on mom:
Integumentary
Melasma (mask of pregnancy) disappears
Vascular abnormalities (varicose veins)
Hair loss (1st 3mo)
Striae
Effects on mom:
Musculoskeletal
Returns to pre-pregnancy state 6 wks after birth
Striae
Return of muscle tone
Diastasis recti abdominis
Mutuality
Bonding
Attachment
Mutuality: infant and parent interact in the process
Bonding: EARLY, skin to skin
Attachment: positive interaction OVERTIME, parent provides safe enviorment
Infant behavior facilitating bonding and attachment
Eye contact
Tracking parent
Smiles
Crying only when hungry or wet/dirty
Grasp reflex
Suckline/feeds
Enjoys being held
Parent behavior facilitates bonding and attachment
Looks, gazes, eye contact
Hovers, attention to infant
Talks, sings, touches infant
Sensitive to infants needs
Interventions to promote attachment
Early contact
Skin to skin
Being in room with baby as much as possible
Awareness of infant cues
Role model bonding behaviors
Phases of maternal adjustment
Dependent (taking in)
Dependent-independent (taking hold)
Interdependent (letting go)
Phases of maternal adjustment
Dependent (taking in)
1-2 days
Excited, desire to review birth
Reliance on others to meet needs still
Phases of maternal adjustment
Dependent-independent (taking hold)
Starts 2-3rd day
Lasts 1 days to several weeks
Learning role
Focus on baby
May start experiencing baby blues
Phases of maternal adjustment
Interdependent (letting go)
Weeks to months
Focus on family and new role
Reassertion of role with partner
Resumption of sexual activity
Baby blues
Peaks
Resolves when
Mild depressive symptoms
Anxiety, irritable, mood swings
Fatigued, overwhelmed
Emotional labile, tearfullness
Peaks at 4-5days and resolves by day 10
Postpartum depression and psychosis
If symptoms continue, intensity from baby blues
May lead to poor bonding, dysfunction, violent thoughts/actions
Suicide, infantcide
Siblings
Involve them
Role adjustment
They may want the attention and have negative behaviors, regression
