Postpartum Flashcards
The six weeks following childbirth
Dramatic physical and psychological changes as the body returns to pre-pregnancy state
Resolve issues r/t labor & delivery
Adapt to new role as mother
Postpartum
Oxytocin-hormone responsible for involution and initiation of breastmilk let-down
–breastfeeding aids in faster involution–afterpains: ibuprofen (helps cramping), Tylenol (helps incisional pain), Percocet
Postpartum changes
returning of the uterus to normal size and position
involution
Position of uterus--fundal check – position mother flat on back, bladder emptied – support uterus with one hand firmlyplaced just above symphysis pubis,fundus palpated with pinkie side of other hand
Postpartum changes - involution
Position measured in relation to fingerbreadths from umbilicus After delivery--fundus at umbilicus or slightly below By 48 hours--2-3 fingers below umbilicus If above umbilicus or displaced to one side--check bladder distention
Involution - fundal check
Should be firm and about the size of a grapefruit
If not firm–”boggy”–risk for bleeding.
Perform fundal massage.
Report if tone becomes boggy after
massaged stopped. May need IV oxytocin
or methergine.
Teach client self fundal massage
Involution - uterine tone
stops post partum hemorrhage by constricting blood vessels
Know range of patient’s BP cause it will raise it
Methergine
1 cause of postpartum hemorrhage
caused by full bladder and cure is voiding
Uterine atony
Greater than 500 mL for vaginal Greater than 1000 mL for C-section #1 Cause--uterine atony Cervical or vaginal lacerations Hematoma--vulvar, vaginal, retroperitoneal Retained placenta
Postpartum hemorrhage
First hour following delivery most critical period
for hemorrhage - worried about uterine atony and lacerations and hemorrhage
Early hemorrhage
– Atony
– Lacerations
– Hematoma
Late hemorrhage
– Retained placenta
– Subinvolution - uterus is tired - at risk for PPH and infection
– Infection
Postpartum hemorrhage (2)
Vaginal discharge after delivery Composed of endometrial tissue, blood, and lymph Assess quantity--increases w/ activity – Heavy--1 large pad saturated w/in 1 hour – Moderate--less than 6 inches on pad – Light --less than 4 inches on pad – Scant--less than 1 inch
Lochia
Assess type (color)
– Rubra–red, duration 1-3 days, small clots,
fleshy odor
– Serosa–pinkish brown, duration 3-10 days, may
have fleshy odor
– Alba–white, mucus-like, 10-14 days, no odor - continues up to 6 weeks
Report foul odor, large clots, or if color returns to rubra
Lochia color
Cervix regains muscle tone but never closes as tightly as in pre-pregnant state Regains thickness and normal dilatation
within 12 hours postpartum May feel bumpy, irregularly shaped upon further cervical checks
Cervical changes
Regains muscle tone gradually
Rugae disappear during labor, reappear 3-4 weeks postpartum
Vaginal changes
Very tender with or without episiotomy or laceration Regains muscle tone in 2-3 weeks if no episiotomy Epis heals superficially in 5-6 weeks but still tender Deep healing may take 6 months Watch for S/S of infection or hematoma
Perineal changes
Ice pack provides comfort, reduces swelling Teach good perineal cares Topical anesthetics may be used – benzocaine spray, Tucks pads Prevent constipation NO intercourse, tampons, douching
Perineal changes (2)
Abdominal wall and muscles regain tone gradually. May exercise lightly during 6 weeks – walking, stretching, Kegels Blood volume returns to normal in 2 weeks – 4-6 # weight loss thru diuresis, blood loss – Hgb/Hct levels fluctuate
Other changes
Urethra is sore and edematous May be difficult to void— epidural effect or swelling, may need catheter Increase fluids to prevent bladder infections
System changes - urinary
Constipation common due to slowed peristalsis, poor abdominal muscle tone, sore perineum, narcotic use Increase fluid and fiber Encourage ambulation Stool softeners--Colace, MOM
GI System
Stretched skin of abdomen gradually regains tone Striae remain but become lighter color May experience increased perspiration due to hormone changes May experience generalized rash
SKin
Vital signs--monitor for hemorrhage and shock Lochia usually less in quantity than vaginal delivery Fundal checks performed carefully I & O--usually have Foley and IV first 24 hours post-op
C-Section
heart rate will increase, respiratory will increase, temperature will lower, looks pale and diaphoretic
signs of hemorrhage and shock
Assess for S/S of infection and
separation
Teach bracing with pillow
Teach incision cares
Incision : c-section
common due to hormones, fatigue, new role, anxiety – Experienced by 85% of women and resolves within 2 postpartum weeks - hormone imbalance and fatigue
Postpartum blues
more serious – Occurs between 2 weeks and 3 months PP – listless, withdrawn, mood swings – does not derive enjoyment from baby – still reality based - chemical imbalance and clinical depression treated with hormone replacement therapy, antidepressants (SSRIs), counseling
Postpartum depression–
very serious, less common – impaired sense of reality – danger to self and baby – need referral to psychiatrist - underlining problem is bipolar and schizophrenia
Postpartum psychosis
1ST PHASE OF MATERNAL ADAPTATION DURING WHICH MOTHER PASSIVELY ACCEPTS CARE, COMFORT & DETAILS ABOUT NEWBORN - 1ST 24 HOURS - MORE PASSIVE
Taking in
2ND PHASE OF MATERNAL ADAPTATION DURING WHICH MOTHER ASSUMES CONTROL OF HER OWN CARE AND INITIATES CARE OF INFANT NURSING INTERVENTIONS - 24-48 HOURS - MORE ASSERTIVE, BUT WANTS REASSURANCE
Taking hold
3RD PHASE OF MATERNAL ADAPTATION THAT INVOLVES RELINQUISHMENT OF PREVIOUS ROLES AND ASSUMPTION OF A NEW ROLE AS A PARENT NURSING INTERVENTIONS - DAY 3-6 - MORE INDEPENDANT - GIVE POSITIVE FEEDBACK ON HER CARE
Letting go
Most Rh negative women become sensitized in first pregnancy with Rh positive infant – This infant is not at risk – Subsequent Rh positive infants are at risk because their blood is attacked by the maternal antibodies formed in response to exposure to first Rh positive infant
Rh sensitization
Rh incompatibility results in fetal
hemolytic anemia
– Fetal erythrocytes destroyed by maternal
antibodies
Results in fetal pathologic jaundice
– Fetus compensates by producing immature
erythrocytes—erythroblastis fetalis
- see in the first 24 hours
- the lower the yellow is the higher the bilirubin is
- bilirubin is stored in GI so feed them to get rid of meconium
Rh sensitization (2)
Infant may die in utero, or shortly after
birth
May require intrauterine transfusion or
transfusion following delivery with Rh
negative, type O blood.
RhoGAM - prevention only
Rh sensitization (3)
More common than Rh incompatibility but causes less severe problems Occurs if maternal blood type is O and fetal blood type A, B, or AB Naturally occurring anti-A and anti-B antibodies transfer across placenta to fetus
ABO incompatibility
May occur in first born infants
Infant becomes jaundiced
– Rarely requires transfusion
– Phototherapy generally successful in resolving
ABO incompatibility (2)
Production of breastmilk Milk production begins in pregnancy – estrogen – progesterone After delivery estrogen and progesterone levels fall and prolactin increases
Lactation
Colostrum in the first 3 days Thick yellow fluid rich in antibodies, proteins, and calories. “Liquid Gold” Small amount but adequate to meet infant’s caloric needs Avoid supplementing
Lactation (2)
Transitional breastmilk “comes in” 3-4 days postpartum Abundant supply may cause engorgement – nurse frequently –Warm packs – ibuprofen 400 mg q 6 hrs Let down reflex-oxytocin stimulates
Lactation (3)
Mature milk by day 8-10 Thin, watery, bluish--”skim milk” Contains everything needed for nutrition--No supplementation Easily digested, natural laxative Changes composition daily to meet needs
Lactation (4)
Contains antibodies, baby protected from maternal illness by antibodies produced Nurse at least 10 minutes per side to reach hind milk rich in protein and fats Frequent nursing increases and maintains adequate milk supply – 8-12 feedings in 24 hours Promotes bonding Hormones released during feedings promote maternal sense of wellbeing and contentment
Lactation (5)
Audible swallowing Mother’s breasts feel less full after feeding BMs--2-5 times QD (by day 3) Voids--4-6 times QD (by day 3) Weight gain 1/2 -1 oz per day, regains birth weight within 2-3 weeks
Signs of adequate infant intake
Cradle and cross cradle
Football hold
Side-lying
Sitting
Breastfeeding position
Lips flanged Tongue on underside of breast Minimal discomfort if proper latch May apply purified lanolin to nipples Prevent chapping--air dry after feedings, change wet breastpads/bra
Proper latch-on
L: latch A: audible swallowing T: type of nipple C: comfort of nipple H: hold (positioning) Scored: 0-2 points for each category
Latch scoring tool
Avoid pumping in 1st 3 weeks Pump just enough to relieve engorgement Try to match infant’s feeding patterns when pumping at work (q 2-3 hours) Store in clean plastic bags or bottles – refrigerator-72hrs, deep freeze 6 months Thaw by immersing in warm water
Pumping and storage
