Revised Spring 2011

It is the period of recovery It is a complex state of the childbearing

experience It is a period of INVOLUTIONINVOLUTION

The responses of the mother to the birth of her infant are influenced by many factors such as:

The uterus needs to return to its pre-

pregnant state. This occurs by:Contraction of the Uterus

Autolysis / Catabolism

Regeneration of the Endometrium

Process of lactation• Suckling• Hypothalamus stimulated

Anterior pituitary Posterior pituitary

Suppression of lactation• Decrease stimulation

Wear a tight fitting bra or binder Do not express milk from the breasets Take shower with back to warm water Ice packs

Tone -- should be firm. Assess by supporting lower portion with one hand and palpate fundus with other. If found boggy, then massage. Do not overmassage. Causes relaxation and more bleeding.

Normal for loss of up to 500 cc during vaginal delivery and 1000 cc in cesarean delivery. Main assessment is for excessive bleeding. Fundus should be firm, midline, and small amt. lochia rubra, no large clots.

May be treated with Methergine. Be sure you assess the B/P prior to giving--hold the dose if elevated >140 / 90

Assess Amount• When did you last change your pad

Assess Odor• Fleshy, not foul smelling Lochia

Remains soft and flabby, appears bruised and may have some lacerations

No longer does the external os have the pre-pregnant appearance -- now appears as a jagged slit not a circle.

May be edematous and bruised. Rugae begin to appear when ovarian

function returns. May teach the mom to do Kegels

exercises to increase the blood flow to the area and aid in healing

May have tears, lacerations, or an episiotomy

Assessing: May need to turn patient into the Sims position to visualize.

Resumption of ovulation Lactation Weight loss

Plasma volume: body rids itself of excess by diuresis (may have 3000ml/day) and diaphoresis

Blood volume• Increase for 24-48 hrs after delivery• Increase blood back to heart when blood from

placenta unit returns to central circulation• Extravascular interstitial fluid is moved into the

vascular system/intravascular• Increased cardiac output mainly r/t increased

stroke volume

Vital Signs • Temperature -- may see a SLIGHT ~100. rise in

temperature because of dehydration and exertion of labor in first 24 hrs

• Pulse -- Bradycardia is common for 6 - 8 days postpartally. RT vagal response to increased sympathetic nervous system stimulation during labor and increase in stroke volume.

• Respirations –begin to fall to normal pre-birth range. • B/P -- should remain steady. Not elevated or

decreased

PREGNANCY POSTPARTUM

WBC – elevated slightly to about 12,000

RBC – increase slightly to about 10 milion.

Hemoglobin – stays about normal at ~ 12 g. Below 10 g = anemia

Hemotocrit – lowers 33-39% RT hemodilution. If drops below 32- 35% = anemia

WBC – leukocytosis is common with values of 20,000 – 30,000 RT increassed neutrophils

RBC – return to normal

Hgb. – normal to see a drop of about 1 gram

Hct – normal to see a drop of about 4 points and then a rise RT > loss of plasma than RBC death

•Plasma fibrinogen (coagulation)

increases

•Plasminogen (lysis of clots) does not rise

•Hypercoagulable state

•assess for homan’s sign

Bowel sounds Passing flatus Bowel movement

• Address risks of constipation• What are some of the causes?

Discuss concerns

Diuresis Overdistention

• Causes• Signs and Symptoms

Signs of UTI

Aches and pains

Decreased levels of Relaxin

Abdominal Wall

Melasma (Mask of Pregnancy) Linea Nigra Striae gravidarum (stretch marks) Hair loss

Decreased sensation Headaches

• Frontal• Postpunctural• Accompanied by blurred vision,

photophobia Pain

Sleep Exercise

Pain• Perineal• Afterbirth• Breast engorgement• Gas distention

During your shift assessment of the postpartum mom’s peri pad, you find

it saturated with lochia rubra.

What would be your nursing interventions now?

Most moms are hungry and eager to eat. Start off slowly to avoid nausea and vomiting.

Diet should include:• High in Protein, vitamin C, and fiber• Increase in fluids

Lactating moms need about 700 extra calories for milk production

Prenatal vitamins and iron supplements are often continued in the postpartum period.

Taking - in • Occurs during day 1 - 3 following delivery. ***Main nursing is to listen and help the mother

interpret events of the delivery to make them more meaningful and clarify any misconceptions

Taking - Hold• Occurs during day 3 to about 2 weeks

postpartum• ***Best time for teaching!

Letting Go Phase• occurs after about 2 weeks

Bond that endures over time. Contact should occur as early as possible and as frequently as possible.

Allow time for attachment to occur with all members of the family

The Claiming Process Includes the identificationOf the baby’s specific Features, relating themTo other family members

“Those long toes are just like his Dad’s”

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