Postpartum Period Flashcards
Postpartum Period
- 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.
Physiological Maternal Changes: Involution
- 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.
Physiological Maternal Changes: Lochia
- 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.
Physiological Maternal Changes: Cervix
Cervical involution occurs, and the muscle begins to regenerate after 1 week
Physiological Maternal Changes: Vagina
Vaginal distension decreases, although muscle tone is never restored completely to the pregravid state.
Physiological Maternal Changes: Ovarian Function and Menstruation
- 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.
Physiological Maternal Changes: Breasts
- 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).
Physiological Maternal Changes: Urinary Tract
- 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.
Physiological Maternal Changes: GI Tract
- usually hungry after birth
- constipation can occur (bowel movement by the second or third day)
- hemorrhoids are common
Physiological Maternal Changes: Vital Signs
- 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.
Postpartum Interventions
- 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
Postpartum Client Teaching
- 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.
Postpartum Discomforts: Afterbirth pains
- 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).
Postpartum Discomforts: Perineal
- apply ice packs during the first 24h to reduce swelling.
- after the 24h, apply warmth by sitz baths
Postpartum Discomforts: Episiotomy
- if done instruct the client to adm perineal care after each voiding.
- encourage use of analgesic spray as prescribed