CARE OF WOMEN AND FAMILIES DURING POSTPARTUM C.

Diuresis: Mechanism by which excess body fluid is excreted after

POSTPARTUM PERIOD delivery. Usually begins within the first 12 hours after delivery.
 The post partum period covers the time period from birth until D. Kidney function returns to normal.
approximately six to eight weeks after delivery. BREASTS
 This is a time of healing and rejuvenation as the mother’s body A. Proliferation of glandular tissue during pregnancy caused by
returns to pre-pregnancy states. hormonal stimulation.
 Healthcare professionals need to be aware of the normal B. Usually continue to secrete colostrum the first two to three days
physiologic and psychological changes that take place in women’s postpartum (PP); enhances immunity and nutrition of infant.
bodies and minds after delivery in order to provide Breast milk (bluish-white, thin) usually produced by third day.
comprehensive care during this period. C. Anterior pituitary: stimulates secretion of prolactin after the
 In addition to patient and family teaching, one of the most placental hormones that inhibited the pituitary are no longer
significant responsibilities of the postpartum nurse is to recognize present  stimulate alveolar (acini) cells  milk.
potential medical complications after delivery. D. In 3 to 4 days, breasts become firm, distended, tender, and warm
UTERUS (engorged), indicating production of milk.
A. Involution: rapid diminution in the size of the uterus as it returns E. Breastfeeding woman: apply warm compress, suckle. Non-
to a non-pregnant state due primarily to a decrease in size of breastfeeding woman: apply cold compress, don’t express milk.
myometrial cells. F. Milk usually produced with stimulus of sucking infant.
B. Lochia: discharge from the uterus that consists of blood from G. Posterior pituitary: discharges oxytocin, alveoli contract, and milk
vessels of the placental site and debris from the decidua. flows in response to sucking “let down reflex.”
C. Placental site: blood vessels of the placenta become thrombosed BLOOD
or compressed. A. White blood cells increase (25,000 – 30, 000/mm3) during labor
LOCHIA and early postpartum period and then return to normal in a few
Lochia is the vaginal discharge after giving birth, containing blood, days.
mucus, and uterine tissue. Lochia discharge typically continues for four B. Decrease in hemoglobin and red blood cells, and hematocrit
to six weeks after childbirth, a time known as the postpartum period usually returns to normal in 1 week.
or puerperium. C. Elevated fibrinogen levels usually return to normal within 1 week.
 Lochia rubra occurs in the first 1-3 days after childbirth. It is GASTROINTESTINAL TRACT
reddish in color. Hence the term “rubra.” It is made up of mainly A. Constipation due to stretching, soreness, lack of food, and loss of
blood, bits of fetal membranes, decidua, meconium and cervical privacy.
discharge. B. Postpartum clients are usually ravenously hungry.
 Lochia serosa is the term for lochia that has thinned and turned ASSESSMENT
brownish or pink in color within 3-7 days. It contains serous A. Check vital signs every 8 hours and prn: decreased blood
exudate, erythrocytes, leukocytes, cervical mucus and pressure, increased pulse, or temperature over 100.4°F (38°C)
microorganisms. indicates abnormality; use pain scale to evaluate comfort.
 Lochia alba is a colorless or whitish, turbid fluid which drains from B. Observe fundus for consistency and level; massage fundus lightly
the vagina for 10-14 days. with fingers if it is relaxed.
AFTERPAINS  Immediately after delivery, fundus is 2 cm below umbilicus
Afterpains are caused by the release of the hormone oxytocin and the  12 hours later it is 1 cm above umbilicus.
subsequent relaxation and contraction of the uterine muscles. Women  Fundus gradually descends into pelvic cavity, and by ninth
may also experience afterpains while breastfeeding as a result of postpartum day should no longer be palpable (1cm or 1
nipple stimulation and the subsequent release of oxytocin. fingerbreadth qd).
Afterpains are usually resolved by the end of the first postpartum week C. Evaluate lochia for amount, color, consistency, and odor. Watch
and can be alleviated by the relaxation techniques and, if necessary, for hemorrhage. Assess color rubra (red, 1-3 days PP), serosa
analgesics, including short-acting nonsteroidal and anti-inflammatory (pink to brownish, 3-7 days PP), alba (creamy white, 10 days PP).
drugs (NSAIDs). D. Check perineum for redness, discoloration, or swelling.
CERVIX AND VAGINA E. Check episiotomy for redness, discoloration, or swelling.
A. Cervix: remains soft and flabby the first few days, and the internal F. Check breasts for engorgement or redness; cracking or inverted
os closes. nipples.
B. Vagina: usually smooth walled after delivery. Rugae begin to G. Assess emotional status of new mother for depression or
appear when ovarian function returns and estrogen is produced. withdrawal.
OVARIAN FUNCTION AND MENSTRUATION H. Assess for problems with flatus, elimination, hemorrhoids, and
A. Ovarian function depends on the rapidity in which the pituitary bladder or bowel retention.
function is restored. I. Observe status of mother-infant relationship.
B. Menstruation usually returns in 4-6 weeks in a non-lactating J. Assess mother-infant feeding quality (see breastfeeding).
mother. K. Assess for thrombophlebitis.
URINARY TRACT L. Assess blood volume (e.g. Rh, hemoglobin, hematocrit, WBCs)
A. May be edematous and contain areas of submucosal hemorrhage IMPLEMENTATION
due to trauma. A. Nursing interventions for first critical hour after birth.
B. May have urine retention due to loss of elasticity and tone and B. Routine postpartum continues after first hour.
loss of sensation from trauma, drugs, anesthesia, loss of privacy.
C. Administer RhoGAM as ordered within 72 hours postpartum to C. Assess parents’ own birth parenting and nurturing.
Rh- negative client who has delivered an Rh- positive fetus (direct D. Evaluate impact of parents’ cultural background.
Coombs’ -negative) and who is not sensitized. E. Assess readiness for parenthood: emotional maturity, pregnancy
D. Maintain I & O until client is voiding a sufficient quantity without planned or planned, financial status, job status.
difficulty. F. Assess physical conditions of mother prior to pregnancy during
 Usually the first voids are measured. labor and delivery, and during puerperium.
 If client fails to void sufficient quantity within 12-24 hours, G. Assess physical conditions of infant at birth, prematurity,
she is usually catheterized. congenital defects, etc. (parents may feel guilty, angry, cheated,
E. and so forth).
F. Teach client perineal care and give perineal care until client is able H. Check for parental career plans.
to do so. I. Assess opportunities for early parental-infant interaction.
G. Encourage ambulation as soon as ordered and as client is able to J. Evaluate parental knowledge of normal growth and
tolerate it; give assistance the first time. development.
H. Encourage verbalization of client’s feelings about labor, delivery, IMPLEMENTATION
and baby. A. Promote optimum parent-infant interactions during the early
I. Give warm sitz bath as soon as ordered. postpartum period (crucial time in parent-infant bonding).
J. Remind client to return for postpartum check-up. Allow period of time for both mother and father to be along with
K. Instruct the seual relations may be resumed as soon as healing infant.
takes place and bleeding stops and client feels comfortable with Allow parents to hold infant in delivery and recovery rooms, and
it. provide rooming-in and privacy.
L. Discuss contraception if client so desires. B. Based upon assessment of parents, plan nursing care. BE sure to
M. Provide opportunities to enhance mother-infant relationship, begin at the same level as parents.
rooming-in, early contract, successful feedings, etc. C. Be alert to parental cues but be careful not to label.
POSTPARTUM PLACES AS OUTLINED BY RUBIN D. Support mother in infant care activities and use these
TAKING-IN PHASE opportunities to promote her self-esteem.
 First 2-3 days. E. Provide a role model for parents.
 Mother’s primary needs are her own: sleep, food F. Plan nursing care to reduce maternal fatigue and anxiety so that
 Mother is usually quite talkative: focus on labor and delivery time with her infant is pleasurable.
experience. G. Explain to parents that it is normal at this time to feel fatigued,
 Important for nurse to listen and help mother interpret events to tense, insecure, and sometimes depressed.
make them more meaningful. H. Anticipatory guidance regarding baby blues, maternal depression
TAKING-HOLD PHASE and maternal psychosis.
 Third postpartum day to 2 weeks varies with each individual. I. Counsel mother on home care plan.
 Emphasis on present mother is impatient and wants to recognize  Rest periods to avoid over fatigue.
self.  Time spent away from baby: to be alone, to be with
 More in control. Begins to take hold of take hold of task of significant other or husband, to be with other children, and
“mothering.” to resume contact with people.
 Important time for teaching without making mother feel  Time for father and baby together.
inadequate success at this time is important in future mother-  Enlist support from husband or significant other to listen and
child relationship. validate emotional distress new mothers may experience.
LETTING-GO PHASE  Encourage to seek professional help if symptoms or
 Mother may feel a deep loss over the separation of the baby from depression are prolonged or severe.
part of her body and may grieve over this loss. BREASTFEEDING
 Mother may be caught in a dependent-independent role wanting ASSESSMENT
to feel safe and secure yet wanting to make decisions. Teenage A. Review intrapartum medications and possible effects on initial
mother needs special consideration because of the conflicts breastfeeding.
taking place within her as part of adolescence. B. Assess degree of physical comfort prior to nursing.
 Mother may in turn feel resentful and guilty about the baby C. Assess breasts and nipples for factors that may decrease
causing so much work. successful breastfeeding experience (flat or inverted nipples,
 May have difficulty adjusting to mothering role. scarring from breast surgery, significantly asymmetrical breasts,
lack of normal pregnancy breast changes, discomfort,
 May feel conflict between the roles of mother and wife.
engorgement).
 May feel upset and depressed at times postpartum blues. If
D. Observe entire infant feeding and assess infant’s position at
depression continues, client requires referral for therapy
breast, latch, suck, and transfer of milk; confirm correct infant
depression may lead to suicide.
position (nose, cheeks, and chin are touching mother’s breast).
 May be concerned about other children.
E. Assess parent’s knowledge base: infant feeding care, maternal
 Important for nurse to encourage vocalization of these feelings
response to cues, infant care of satiety, importance of feeding,
and give positive reassurance for task until done.
proper techniques, breast care, infant weight gain, maternal
ASSESSMENT
nutrition, personal plans, resources for support, coping with
A. Assess maternal and paternal physical and emotional status.
return to work while breastfeeding.
B. Determine what parents know about infant care.
F. Assess nutrition and hydration status: increased maternal needs
for protein, vitamins, iron, ad fluids during lactation.
G. Evaluate emotional responses toward nursing: satisfaction,
relaxation, mastery.
H. Evaluate LATCH (latch on, audible swallow, type of nipple,
comfort help).
IMPLEMENTATION
A. Complete hand hygiene.
B. Provide skin-to-skin contact between mother and child
immediately after birth, unless contraindicated.
C. Assist mother with breastfeeding as soon as possible after birth,
once mother is comfortable ad infant demonstrated feeding care,
usually within the first hour.
D. Assist mother to a comfortable position (sitting or side lying),
using pillows for support to enhance relaxation and proper
positioning.
E. Guide baby to breast; stimulate rooting, if necessary; place as
much of areola in baby’s mouth as possible.
F. Release suction by inserting a finger into side of baby’s mouth.
The breast will become sore if baby is pulled from it.
G. Burp baby after each breast.
H. Encourage mothers to feed infants at least q 3 hours or at least 8
times in 24 hours.
I. When possible, avoid use of pacifier and supplemental water or
formula until infant is able to latch on and is successfully
breastfed.
J. Teach mother and significant other importance of obtaining
adequate rest, breast massage, correct latching,
engorgement/nipple soreness, breastfeeding patterns,
breastfeeding positions, determining adequate intake.
K. Promote comfort by carefully managing/preventing sore nipples
(proper positioning; express colostrum or breast milk in nipple
and areola at end of q feeding hind milk; moist compresses) and
breast engorgement (feed on demand, use warm compresses;
breast massage and manual expression prior to nursing; warm
shower when feedings observe for signs of mastitis; wear well-
fitting, supportive bra).
Nutrition counseling: Additional 500 calories in well-balanced diet.
Drink 3000 ml fluid qd.
L. Uterine cramping may occur the first few days after delivery while
nursing, due to oxytocin stimulation, which also causes uterus to
contract.
M. Counsel mothers to avoid:
 Medications or drugs contraindicated unless necessary to
client’s life – drugs pass to infant through breast milk.
 Some food, such as cabbage or onions, may alter the taste
of the milk or cause gas in infant.
 Birth control pills are often avoided as milk production may
be decreased and the medications is passed to infant in the
milk.
N. Explain contraindications to breastfeeding:
 Active tuberculosis.
 Severe chronic maternal disease.
 Narcotic addiction drug abusers must be drug-free for
months.
 Severe cleft lip or palate in newborn.
 HIV-positive status; AIDS.