Postpartum Period

Question 1

Postpartum Period

Answer 1

• period when the reproductive tract returns to the normal, nonpregnant state.
• starts immediately after birth and is usually completed by week 6 following the birth.

Question 2

Physiological Maternal Changes: Involution

Answer 2

• rapid decrease in the size of the uterus
• clients who breast-feed may experience a more rapid involution because of the release of oxytocin during.
• endometrium regenerates
• fundus steadily descends into the pelvis
• fundal height decreases about 1 cm/day
• by 10 days the uterus cannot be palpated abdominally
• a flaccid uterus indicates atony, and it should be massaged until firm; a tender fundus indicates infection.
• afterpains decrease in frequency after the first few days.

Question 3

Physiological Maternal Changes: Lochia

Answer 3

• discharge from the uterus that consists of blood from the vessels of the placental site and debris from the decidua
• should smell like normal menstrual flow
• decreases daily in amount
• rubra is bright red discharge that occurs from day of birth to day 3.
• serosa is brownish pink discharge that occurs from days 4 to 10.
• Alba is white discharge that occurs from days 11 to 14.

Question 4

Physiological Maternal Changes: Cervix

Answer 4

Cervical involution occurs, and the muscle begins to regenerate after 1 week

Question 5

Physiological Maternal Changes: Vagina

Answer 5

Vaginal distension decreases, although muscle tone is never restored completely to the pregravid state.

Question 6

Physiological Maternal Changes: Ovarian Function and Menstruation

Answer 6

• ovarian function depends on the rapidity with which pituitary function is returned.
• menstrual flow resumes within 1 to 2 months in non-breast-feeding mothers.
• menstrual flow usually resumes within 3 to 6 months in breast-feeding mothers (they might experience amenorrhea during the entire period of lactation so long as it is exclusively).
• women may ovulate without menstruating, so breast-feeding should not be considered a form of birth control.

Question 7

Physiological Maternal Changes: Breasts

Answer 7

• breasts continue to secrete colostrum for the first 48 to 72h after birth.
• a decrease in estrogen and progesterone levels after birth stimulates increased prolactin levels.
• breasts become distended with milk on the third day
• engorgement occurs on approx day 4 (amametando ou nao) and breast-feeding relieves.
• non-breast feeding mothers: avoid nipple stimulation, apply breast binder, apply ice packs (usually resolves around 24-36h after begins).

Question 8

Physiological Maternal Changes: Urinary Tract

Answer 8

• may have urinary retention as a result of loss of elasticity and tone from trauma, meds, anesthesia, and lack of privacy.
• diuresis usually begins within the first 12h after birth.

Question 9

Physiological Maternal Changes: GI Tract

Answer 9

• usually hungry after birth
• constipation can occur (bowel movement by the second or third day)
• hemorrhoids are common

Question 10

Physiological Maternal Changes: Vital Signs

Answer 10

• Temperature: may increase to 100.4 F (38C) during the first 24h postpartum because of dehydration (higher may be infection and must be reported).
• Pulse: may decrease to 50 bpm. >100 may indicate excessive blood loss or infection.
• BP: should be normal.
• Respirations: rarely change.

Question 11

Postpartum Interventions

Answer 11

• monitor VS
• assess pain level
• assess height, consistency, and location of the fundus
• monitor color, amount, and odor of lochia
• assess breast for engorgement
• monitor perineum for swelling or discoloration, lacerations, or episiotomy for healing.
• assess incisions and dressings (c-section)
• monitor bowel status, intake and output
• encourage frequent voiding and ambulation
• assess extremities
• adm Rho immuno globulin if necessary
• evaluate rubella immunity and vaccinate if needed
• assess bonding with the newborn
• assess emotional status

Question 12

Postpartum Client Teaching

Answer 12

• newborn care skills
• feeding technique
• avoid heavy lifting for 3 weeks at least
• plan 1 rest period per day
• contraception should begin after birth or with initiation of intercourse (which should be postponed until lochia ceases.
• schedule follow up in 4 to 6 weeks and explain the importance
• instruct to report any signs of chills, fever, increased lochia, or depressed feelings.

Question 13

Postpartum Discomforts: Afterbirth pains

Answer 13

• occurs as a result of contractions of the uterus.
• are more common in multiparas, breast-feeding mothers, clients treated with oxytocin, and clients who had an overdistended uterus during pregnancy (such as twins).

Question 14

Postpartum Discomforts: Perineal

Answer 14

• apply ice packs during the first 24h to reduce swelling.

- after the 24h, apply warmth by sitz baths

Question 15

Postpartum Discomforts: Episiotomy

Answer 15

• if done instruct the client to adm perineal care after each voiding.
• encourage use of analgesic spray as prescribed

Question 16

Postpartum Discomforts: Perineal Lacerations

Answer 16

• care as for an episiotomy, adm perineal care and use analgesic spray.

Question 17

Postpartum Discomforts: Engorgement of breasts

Answer 17

• encourage to wear a support bra at all times, even when sleeping.
• encourage the use of ice packs if the client is not breast-feeding.
• encourage the use of warm soaks or a warm shower before feeding for the breast-feeding mother.
• adm analgesics as prescribed.

Question 18

Postpartum Discomforts: Constipation

Answer 18

• encourage adequate intake of fluids (2L/day)
• diet high in fiber
• ambulation
• stool softener, laxatives, enema or suppository if needed and prescribed.

Question 19

Postpartum Discomforts: Emotional changes

Answer 19

• acknowledge the client’s feelings and demonstrate a caring attitude.
• encourage to verbalize her feelings
• monitor newborn for growth and development expectations.
• determine family support or other support systems
• assist significant other and family members.

Question 20

Nutritional Counseling

Answer 20

• discuss calorie intake with breast-feeding mothers (needs to increase 200-500 calories/day)
• may require increased fluids and continuance of prenatal vitamins and minerals.

Question 21

Breast-feeding

Answer 21

• put the newborn to the mother’s breast as soon as possible (both conditions stable)
• stay with the client each time she nurses until she feels secure.
• Assess LATCH
• uterine cramping may occur.
• instruct to use general hygiene and wash the breast once daily.
• if engorgement occurs, breast-feed frequently, apply warm packs before feeding, apply ice packs between feedings, and massage the breast.
• client should not use soap on the breasts because it tends to remove natural oils (increasing chance of cracked nipples)
• if cracked nipples develop, client should expose the nipples to air for 10 to 20 min after feeding, rotate the position of the baby for each feeding, and ensure the baby is latched on to the areola. Colostrum can also be expressed after the feedings as a moisturizer for the nipple.
• bra should be well fitted and supporting, avoid underwire.
• breasts may leak, place pads.
• newborns stool are usually light yellow, seedy, watery, and frequent.
• meds should be avoided (unsafe for breast-feeding)
• gas producing foods and caffeine should be avoided.
• oral contraceptives containing estrogen are not recommended. Progestin-only birth control pills are less likely to interfere with the milk supply.

Question 22

LATCH

Answer 22

Latch achieved by newborn
Audible swallowing 
Type of nipple
Comfort of mother
Hold or position of baby