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Postpartum Nursing. Postpartum or Puerperium. Period of 6 wks after delivery during which the reproductive system and the body returns to normal immediate--first 24 hrs early--first week late--2nd to 6th week. Dramatic Changes in every body system.

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postpartum or puerperium

Postpartum or Puerperium

Period of 6 wks after delivery during which the reproductive system and the body returns to normal

immediate--first 24 hrs

early--first week

late--2nd to 6th week

dramatic changes in every body system
Dramatic Changes in every body system
  • While Changes are normal, in no other period of life is there such marked and rapid catabolism
  • Wt. Loss ot 15-17 lbs. Possibly more if breastfeeding.
changes in the following










Blood Changes

Vital Signs

Abd. musculature

Sleeping and rest


Changes in the following:
uterine involution
Uterine Involution
  • Blood vessels contract, uterus shrinks
  • Involutes at 1cm/day 1cm=1fingerbreadth
  • Below the symphysis by 10-12 days
  • Process for involution=autolysis of protein
    • 1000gm at delivery, 60gm at 6 wks pp
  • Outer decidua and autolysed protein excreted in lochia
  • Inner decidua forms new endometrium
  • Entire endometrium restored in 3 wk, except for placental site
  • Large bld vess. degenerate, replaced by smaller ones.
  • Cervix never returns to nulliparous state
nursing care r t uterine changes
Nursing care r/t uterine changes
  • Palpate fundus at frequent intervals
    • q. 15” X 1hr
    • q. 1hr X 2
    • q. 2hr X 2
    • q. 4 hrs up to 24-48 hrs. post delivery
  • Massage if not firm
  • Deviation and above umb. may signal full bladder
  • Vaginal discharge after delivery,composed of leukocytes, epithelial cells, decidua, autolysed protein and bacteria.
    • Rubra--delivery to 3rd day
    • Serosa--days 4-10
    • Alba--10--several weeks post delivery

Assess color, amt, odor, clots

cramping or afterpains
Cramping or “Afterpains”
  • Primigravida--uterus tonically contracted unless clots or tissue remain in uterus.
  • Multipara--uterus contracts and relaxes at intervals causing “afterpains”.

More severe when breasfeeding in both primiparas and multiparas.

breast changes
Breast Changes
  • Colostrum secreted from third tri. until lactation begins
  • Milk--lactation 3rd pp day
  • Engorgement from increased vascular and lymphatic circulation
  • Decreased/absent placental hormones cause prolactin to be secreted=lactation

Check breasts for engorgement, nipple cracks, soreness

suppression of lactation
Suppression of Lactation
  • Avoid breast stimulation
  • Ice
  • Tight bra
  • Do not pump or express milk
  • Homonal suppression (rarely)
perineal changes
Perineal Changes
  • Episiotomy--subcuticular sutures
  • Pain for 24-48 hrs
    • ice for 24 hrs then heat (sitz baths)
    • Analgesics, systemic and topical
    • Sit properly
    • Keep clean--perineal care
evaluate episiotomy or perineal lac for reeda
Evaluate Episiotomy or Perineal lac. for REEDA
  • Redness
  • Edema
  • Ecchymosis
  • Drainage
  • Approximation
vaginal changes
Vaginal Changes
  • rugae absent--return in 3 wks
  • edematous--venous congestion for 3 days
  • distention--decreases but never back to nulliparous state
  • lacerations
  • hymenal tags
  • labia flabby, improve but never back to nulliparous state
urinary elimination
Urinary Elimination
  • Bladder Changes
    • edema and hyperemia,extravasation
    • increased capacity, decreased sensitivity
    • overdistension with incomplete emptying
    • urethral trauma may cause dysuria

Note, transient glycosuria, proteinuria, and keytonuria are normal in immediate pp. period.

problems with urinary elimination
Problems with urinary elimination
  • Dysuria
  • IV fluids cause bladder fullness
  • regional anesthesia and decreased abdominal pressure=pt unaware of full bladder
nursing care
Nursing Care
  • Check bladder frequently post delivery
  • Full bladder can inhibit uterine contraction=bleeding

Signs of full postpartum bladder=uterus high and displaced to side (usually R)

  • If no void in 4-6hrs, catheterize
  • Check amount of voiding (retention with overflow possible)
retention with overflow
Retention with overflow
  • When bladder is overdistended pt. will void small amouts without emptying bladder.
  • If catheterize for an overdistended bladder, remove only 1000cc and then clamp and consult MD
  • If unable to void after cathX2, Foley indicated
bowel elimination
Bowel Elimination

Constipation r/t

  • decreased peristalisis
  • decreased intra abdominal pressure
  • hemorrhoidal discomfort
  • perineal discomfort

Increase roughage and fluids, laxatives and suppositories--bowels normal by 1wk pp

endocrine changes
Endocrine Changes
  • Placental estrogen and progesterone removed
  • Prolactin increases, esp in breastfeeding women
  • Estrogen begins to increase to follicular levels at 3-4 wks p. Delivery
  • Menstruation returns--6 wks not breastfeeding, 2-18 mos breastfeeding
cardiovascular changes
Cardiovascular Changes
  • Blood volume goes rapidly from hypervolemia to hypovolemia
    • blood loss 400-500cc vaginal delivery

700-1000 cc Csection

blood components
Blood Components
  • HCT (down 4pts for each pt blood lost)
  •  Leucocytes(15,000 to 30,000 mm3)
  •  Lymphocytes
  •  Fibrinogen--risk of thrombophlebitis
  •  ESR
vital signs
Vital Signs
  • BP first  then 
    • increases during uterine massage/pain
    • if PIH may stay elevated
    • orthostatic hypotension common
  • Temp first  then 
  • P-- 
  • R-- 
other changes
Other changes

Postpartum Chill

Shaking chill due to vasomotor instability

Postpartum diaphoresis

night sweats and increased odor

abdominal musculature
Abdominal Musculature
  •  muscle tone--soft, weak, flabby
  • diastasis recti remains

May do head and shoulder raises and lie on abdomen--ask MD about resumption of more vigourous activity

(other muscles may be weak due to the exertion of delivery and lactic acidosis)

sleep and rest patterns
Sleep and Rest Patterns
  • Sleep and rest patterns disrupted during thrird trimester and continue to be disrupted during pp period
    • excitement
    • anxiety
    • discomfort
    • baby feedings
psychological changes
Psychological Changes

The new mother must move from dependent to independent in a short time

Reva Rubins three stages of the postpartum

  • Taking in
  • Taking hold
  • Letting go (taking over)
taking in phase
Taking in phase
  • Focused on self (not infant)
  • dependent on others for help in care
  • needs assistance
  • decision making difficult
  • comfort-rest-food needs paramount
  • relives delivery experience

May last for several hours or days

taking hold phase
Taking hold phase
  • Moving from dependence to independence
  •  energy level
  •  focus on infant
  • self care, focus on bowels, bladder, brfeed
  • responds to instruction, praise

Lasts from 2days to 1wk

letting go phase
Letting go phase
  • Giving up previous role
  • See self as separate from infant
  • Give up fantasy delivery and baby
  • Readjustment
  • Depression and grief work
  • from 1wk
postpartum blues
Postpartum blues
  • Reduction of progesterone, delayed prolactin release and changes in other placental hormones may trigger emotional instability
  • Body image changes and dependency needs may contribute
  • Overconcern re infant and self, and emotional lability are “normal” during the first 5-10 days after delivery
postpartum depression
Postpartum depression
  • Rejection of infant, or fears that she may harm infant call for immediate intervention.
  • Remind mom during postpartum teaching that these feelings sometimes occur and help is available