Postpartum Care Flashcards
Ø Postpartum Care is defined as the 6 weeks that follows delivery of
the infant.
l also referred to puerperium
Common Conditions Immediately PostPartum
Perineal pain:
l Vaginal deliveries: 60% of women
continue to experience 1 week
later
l Resolves within 6 weeks
l The > degree of trauma to the area
> pain:
l episiotomy
l third or fourth degree tears
Episiotomy
Now, episiotomies aren’t done in all individuals now unless there’s a potential risk of more trauma to the area with delivery. So they would most currently now I believe they recommend a medial lateral episiotomy sort of kind of sideways a little bit because the mid-line episiotomy, what could happen with a mid-line episiotomy is that it could it could continue to tear and go down to the anus
medial lateral episiotomy has greater pain associated with it afterwards, but less risk of more complications.
Obviously someone who has an episiotomy, then they’re going to have more pain during that time, right? And they’re gonna need help and treatment with it
The second-degree tear goes a little bit deeper into that open into the muscle layer. And then the third degree tear is actually almost to the anus Lot more tear. And then obviously this would be terrible, is the fourth degree tear would be completely up to the anus
o it’s something we’re trying to prevent by doing the episiotomy in some of those individuals, especially if they have like gestational diabetes,g. and every really big baby and they wanna do a vaginal delivery. .
tx for perineal pain
Treatment:
* Sitz baths,
* Rinse area with warm water,
* Kegel exercises to prevent
* Hamamelis (witch hazel)
* Acetaminophen or NSAIDs
he recommendation is just, you can just recommend in a tub with some warm water, not hot water, but warm water, but two to 3 “ enough when they sit down that it covers that area. And they could sit for five to 10 min or so. And then they recommend frequently anywhere 4-5 times a day if they have the time or may not have the time at the little baby, but trying to maintain during the times that would be the highest. Pain.
Before delivery, good pelvic muscles
Wipes for the area
you can use some of the hemorrhoid types and there might be products specifically for postpartum women as well, where they have a topical anesthetic that you might have talked about, even hydrocortisone cream to the area. And physicians may prescribe that as well to help with that if there’s more severe issues
Considerations Immediately Postpartum
Other considerations:
Ø Vaginal discharge – lochia
Ø Cramping
Ø Constipation
Ø Hemorrhoids
Ø Urinary incontinence
And it’s just it looks like kinda like a period, really heavy. It’s kinda remnants of the uterine lining. The placenta is usually gone, but there might be remnants of that uterine lining because it’s thickened and for the delivery. And it looks just like heavy bleeding.
ramping can happen as the uterus starts to kind of get back to its regular size, constipation
hemorrhoids is common during this time, not only during the pregnancy, but esp, especially postpartum
Common Ailments in the Postpartum: Issues
with Breastfeeding
Cracked Nipples:
Cracked Nipples:
Ø Ensure correct latching of baby
Ø Warm wet compresses
Ø Lanolin
Ø Acetaminophen or NSAIDs for pain relief
Note: For painful, engorged breasts: warm showers just before feeding, cold compresses in
between feeds will help.
Common Ailments in the Postpartum: Issues
with Breastfeeding
Mastitis:
inflammation of the breast
causes: blocked milk duct or infection
Common Ailments in the Postpartum: Issues
with Breastfeeding
Mastitis from blocked milk duct
Ø Soreness, redness, sometimes hard, tender lump (”hot spot”) in
area of blocked milk duct
Ø Warm wet towels/massage before feeding
Ø Increase fluids
Ø Increase number of breast feeding on the affected side
Ø Acetaminophen or NSAID’s for pain
Ø If no improvement in 24 hours or fever develops see health care
professional
Common Ailments in the Postpartum: Issues
with Breastfeeding
Mastitis from infection:
Ø Similar to blocked milk duct symptoms including redness hot spot
on breast(s), fever, flu like symptoms
Ø Encourage milk flow from affected breast either breast feeding or
breast pump
l Can continue breast feeding while on therapy
Ø Hot compresses may help
Ø Usual pathogen: Staph. aureus Oral antibiotics: cloxacillin, cephalexin
(clindamycin if beta lactam allergy or
MRSA), IV antibiotics if severe
Patient Case
Ø Latisha (they/them) is a 33 year old first time mom. Latisha’s little
boy was born about 4 months ago. Latisha is currently
breastfeeding, but has noticed a small red lump on the left breast
for the last day. Latisha’s left breast is also sore, feels inflamed
and slightly reddish color. They report no fever nor any other
symptoms.
What would you recommend for Latisha?
Monitor for 24 h. Macetaminophen ake sure just one of the things to keep in mind and just to monitor is if they do take that the fever, they may not see a fever as well.
That’s really important is just keep breastfeeding on that and reassure them that that’s going to actually help with that milk flow because they’re gonna be scared probably doing something harmful for the baby.
Warm compress
Postpartum blues:
l Up to 75% of postpartum people
l Onset usually day 3 – 4 postpartum and may last up to 2 – 4 weeks
after delivery
l Symptoms include mood changes – from happy episodes to feeling
uncontrollably sad, and may have inexplicable spells of irritability,
weepiness, and anxiety.
l No treatment required other than reassurance and support.
Amy: I feel awful. My head hurts, I am exhausted, and feel
so down. I have no joy, even though there is this beautiful
little girl in my arms, I feel nothing. This is not how I imagined
this being. I have been depressed before but this feels
worse. I am worried about my baby and that she may get sick.
I am worried about that my partner will have a car accident
and that I will be left all alone with the baby…
Postpartum depression (PPD):
l 10 – 15% of postpartum people
l Term used to describe non-psychotic depression that occurs
shortly after childbirth.
l Symptoms can start from 4 weeks to 12 months after
delivery.
l Some patients may be primarily anxious – could be termed
Postpartum anxiety
The key for Amy was it it’s later than the four weeks that the eight weeks that she’s still continuing to experience. So usually symptoms start after that four weeks and it can occur up to 12 months after the delivery.
Lisa, 29 years old, had a healthy baby boy 5 days ago.
Ø Husband: Lisa appeared ecstatic after the birth but in the
last few days is very difficult to be with. Lisa has not slept
much since the birth and is doing weird things like cleaning
the house in the middle of the night and never finishing
anything she starts. Lisa is having difficulty carrying on a
conversation as jumps around from topic to topic. Lisa has
not been able to care for the baby. I am worried about
leaving Lisa alone with the baby as I have seen Lisa leave
him unattended on the kitchen floor while they went to go
clean another part of the house
Postpartum psychoses:
l Least common – 0.1 – 0.2%
l Onset is rapid – often within a 48 – 72 hours after birth.
l Most common symptoms are extreme depression or elated
mood or can fluctuate rapidly between the two. Also may have
delusions, hallucinations (auditory or visual).
l Cases of infanticide or suicide are rare but a serious risk with
postpartum psychoses.
l Requires immediate intervention!
That the typical thing with postpartum psychosis is the onsets quick. It happens quickly after the delivery, anywhere 2-3 days after the delivery. Usually it’s extreme. Emotions from extreme depression or extreme mood can fluctuate. They can have also like delusions, hallucinations as well. Now, cases of infanticide or, or infanticide or suicide are rare, but serious risk.
What causes PPD?
Ø Complex interplay of physical, hormonal, social, psychological
and emotional factors.
Ø Factors that trigger PPD vary from one individual to another
Risks for PPD
Ø History of previous PPD (40% if previous PPD)
Ø Depression or anxiety during pregnancy
Ø History of previous depression
Ø Family history of depression
Ø Presence of poor social supports
Ø Poor marital relationship
Ø Stressful life events
Ø Obstetrical complications
And that’s where they’ve had a really traumatic delivery, e.g. if they were trying to have a vaginal delivery and they weren’t able to have the baby and then g.
they had to go have an emergency C-section e. right. That’s a traumatic delivery. These individuals would be possibly at greater risk. And it’s actually been reporting, it’s almost like the PTSD type of a thing
Impact of Postpartum depression
Ø May be reluctant to discuss or admit to having symptoms.
l Feel guilty or think they are bad mothers
l Cultural issues
Ø Major impact on family
l Mother-child relationship
l Compromised ability to look after themselves and their newborn
