3 Post Partum Adaptations

Question 1

Postpartum is classified as what

Puerperium?

Answer 1

Postpartum: birth to return of the reproductive organs to their non pregnant state (approximately 6 wks)

Puerperium: 4 trimesters

Question 2

Uterus

What we want: involution

What we dont: subinvolution

Answer 2

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

Question 3

Contactions:

Ways we get oxytocin
Afterpains

Answer 3

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)

Question 4

Assesssment of lochia

Answer 4

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)

Question 5

Assessment of cervix, vagina, and perieum

Answer 5

Episotomy and laceration assessments

Hemorrhoids

Question 6

Pelvic muscular support

Answer 6

Kegel exercises

Question 7

Breast feeding mothers

What for the 1st 24hrs
Transitions to what by when
How to tx engogement

Answer 7

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

Question 8

Non breastfeddin mothers

Engorged when
Resolves how and when
Tx

Answer 8

Engorged 3-4th day

Resolves spantaneouly and decreased within 24-36hrs

Tx:
-icepack
-painrelievers
-supportive bra
(NO STIMULATION)

Question 9

Effects on mom:

Cardiovascular

Answer 9

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

Question 10

Effects on mom:

Respiratory

Answer 10

Decreased pressure on diaphragm

Breath sounds clear

Sudden chest pain & resp distress (PE/AFE????)

Question 11

Effects on mom:

Endocrine

Answer 11

Prolactin remains elevated for mothers breastfeeding

Menstruation returns 7-12wks non-lactating

Menstruation 3mos-1yr lactating

Question 12

Effects on mom:

Fluids/urinary

Answer 12

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

Question 13

Effects on mom:

GI

S/s
Tx

Answer 13

Increased appetite
Fear of bowel movement
Constipation
Hemorrhoid

Tx:
Stool softener
Teach prevention of constipation

Question 14

Effects on mom:

Integumentary

Answer 14

Melasma (mask of pregnancy) disappears

Vascular abnormalities (varicose veins)

Hair loss (1st 3mo)

Striae

Question 15

Effects on mom:

Musculoskeletal

Answer 15

Returns to pre-pregnancy state 6 wks after birth

Striae

Return of muscle tone

Diastasis recti abdominis

Question 16

Mutuality

Bonding

Attachment

Answer 16

Mutuality: infant and parent interact in the process

Bonding: EARLY, skin to skin

Attachment: positive interaction OVERTIME, parent provides safe enviorment

Question 17

Infant behavior facilitating bonding and attachment

Answer 17

Eye contact
Tracking parent
Smiles
Crying only when hungry or wet/dirty
Grasp reflex
Suckline/feeds
Enjoys being held

Question 18

Parent behavior facilitates bonding and attachment

Answer 18

Looks, gazes, eye contact
Hovers, attention to infant
Talks, sings, touches infant
Sensitive to infants needs

Question 19

Interventions to promote attachment

Answer 19

Early contact
Skin to skin
Being in room with baby as much as possible
Awareness of infant cues
Role model bonding behaviors

Question 20

Phases of maternal adjustment

Answer 20

Dependent (taking in)

Dependent-independent (taking hold)

Interdependent (letting go)

Question 21

Phases of maternal adjustment
Dependent (taking in)

Answer 21

1-2 days

Excited, desire to review birth

Reliance on others to meet needs still

Question 22

Phases of maternal adjustment

Dependent-independent (taking hold)

Answer 22

Starts 2-3rd day
Lasts 1 days to several weeks

Learning role

Focus on baby

May start experiencing baby blues

Question 23

Phases of maternal adjustment

Interdependent (letting go)

Answer 23

Weeks to months

Focus on family and new role

Reassertion of role with partner

Resumption of sexual activity

Question 24

Baby blues
Peaks
Resolves when

Answer 24

Mild depressive symptoms

Anxiety, irritable, mood swings

Fatigued, overwhelmed

Emotional labile, tearfullness

Peaks at 4-5days and resolves by day 10

Question 25

Postpartum depression and psychosis

Answer 25

If symptoms continue, intensity from baby blues

May lead to poor bonding, dysfunction, violent thoughts/actions

Suicide, infantcide

Question 26

Siblings

Answer 26

Involve them

Role adjustment

They may want the attention and have negative behaviors, regression