Normal Postpartum (Ch. 15-16)
Postpartum = period of time immediately after delivery through 6 weeks. Maternal body returning to prepregnant state.
1. Discuss the following physiologic adaptations in the postpartum period.
Uterus
Involution shrinking of an organ when inactive (uterus, cervix). Fundus
descends 1cm/day.
Patients who are breastfeeding will experience more rapid shrinking due to
oxytocin release.
By 14 days, uterus cannot be palpated.
At 6 weeks, back to pre-pregnant size.
Failure of the uterus to return to prepregnant state is called: subinvolution.
Causes include: retained placenta, fragments or membranes,
distended bladder.
Complications include: hemorrhage, pelvic peritonitis, salpingitis, abscess formation.
Lochia because fetus has occupied the uterus for 9 months, the lining has not shed as it normally does with each
menstruation. The lining is no longer needed and must be shed.
Postpartum mothers will experience vaginal bleeding for up to 6 weeks as the uterine lining is shed.
3 stages of shedding: should not go from red to brown and back to red.
Rubra bloody
Serosa brownish pink (4-10)
Alba milky white
Most accurate way to determine amount of lochia = weigh pad before and after use
Heavy amount = saturating a pan in 1 hour
Excessive amount = saturating in 15 minutes
1 g = 1 mL
Considered a hemorrhage for c-section: 1000 mL
Vaginal delivery: 500 mL
Menstruation
Return to normal cycle depends if mother is breastfeeding or not
Breastfeeding moms may have amenorrhea but may still ovulate.
Education important!! Some may rationalize that if they do not have their normal monthly
bleeding that they cannot get pregnant again – not true!
Non-breastfeeding moms will return in 4-6 weeks..
Afterpains pains after birth from uterine contractions.
Due to the release of oxytocin; breastfeeders will have more.
Can give meds: ibuprofen, oxycodone or Tylenol
Heating pads
Patients more likely to experience afterbirth pains: breastfeeders, those given oxytocin, moms who have
overdistended uterus (carrying multiples), multiparas, polyhydramnios, large baby
The more babies you have had, the more pain you will have when it comes to breastfeeding.
Breasts
Estrogen + progesterone levels plummets = prolactin levels and therefore milk production.
Colostrum secreted first 3-4 days
Milk comes in on day 5-6
Mothers not breastfeeding will still have milk come in
No nipple stimulation
Wear tight bra
Keep warm water on back
Cabbage leaves (?)
Milk production typically stops after 5-7 days
Discomforts: engorgement, nipple damage, clogged ducts, mastitis
Cervix/vagina
Decreased tone will likely never return to pre-pregnancy state
Cervix closes in 2 weeks. Should return to normal in 6 weeks.
Vagina lubrication.
Mucosa thickens and rugae returns when estrogen production
resumes.
Rev. Fall 2019. Maria Jabeguero
, Normal Postpartum (Ch. 15-16)
Monitor for signs of infection
Icepacks can be used for vaginal swellings
For pelvic muscles to return to normal… teach patient how to do “kegels” exercises.
Perineum
Swelling and bruising heals.
Episiotomy takes 4-6 months to heal.
How can the nurse promote comfort and healing?
Sitz baths can be done in small basin over the toilet or at home in a baths
Ice packs during 24 hours and sitz baths thereafter relieves swelling and provides substantial pain relief.
Analgesic sprays may be helpful for lacerations and incisions
Clean perineal area after every trip to the bathroom
Splint incision when coughing
Vital signs
Temperature: elevated up to 100.4 in first 24 hours.
BP: possible orthostatic hypotension
RR: 16-20 per minute
HR: bradycardia for 2 weeks pp (there’s a in CO because of blood flow)
Cardiac and hematologic
What is considered anemia?
What is a normal lab value for WBC’s during the early postpartum period?
Coagulation
Thromboembolism risk
Measure blood loss at time of delivery.
BV over 2 weeks from diuresis and diaphoresis.
WBCs which in labor remain evaluated 4-6 days.
Hematocrit and hemoglobin stay stable unless there’s heavier bleeding.
Clotting factor high in pregnancy and remains high 2-3 weeks pp.
Hypercoagulability and vessel damage during birth and immobility place woman at risk for blood clots (embolism) in
legs and arms.
Urinary system
Encourage regular emptying of the bladder to prevent urinary retention and displacement of uterus.
What are some special situations which might impede urination?
Trauma, meds, anesthesia, etc.
Excessive output/diuresis the first 12 hours post-delivery due to fluid shifts
Diuresis of up to 3000 ml/day is normal.
Fluid built up from IVs received.
Anti-diuretic effect of decreasing oxytocin after delivery.
edema
GI system
appetite
Hemorrhoids and constipation are common
Due to ↓ motility, constipation are common. Can also be due to fear of defecation because of episiotomy.
Administer stool softeners as ordered.
Tuck pads can be used for hemorrhoids.
Hydration and ambulation will help with constipation AND breast milk production.
Neurology
Headaches if they have had spinal or epidural.
Motor function of lower extremities effected by epidural.
Urinary retention
MS system
Muscle tone returns and joints return to pre-pregnant state.
Diastasis recti: separation of the rectus muscle. Usually resolves in 6 weeks.
Skin estrogen and progesterone causes linea nigra, melasma, stretch marks to diminish.
Hair growth is dormant during pregnancy. PP, estrogen levels puts hair growth back in process.
Respiratory System
Back to pre-pregnant state in 1 week, less SOB
Endocrine system
Rev. Fall 2019. Maria Jabeguero
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