Care of Postpartum

1. Care of the Mother During the Postpartum Period

2. Nursing Care of the Mother Mother means; - Postpartum women - Puerperial women - After
childbirth women The puerperium is the period beginning after delivery and ending when the
womans body has returned as closely as possible to its prepregnant state. The period lasts
approximately 6 weeks.
3. Physiologic Changes of the puerperium 1. Uterine changes a. The fundus is usually midline
and about at the level of the womans umbilicus after delivery. Within 12 hours of delivery, the
fundus may be 1cm above the umbilicus. After this, the level of the fundus descends about 1
finger breadth (or 1 cm) each day, until by the 10th day, it has descended into the pelvic cavity
and can no longer be palpated.
4. Level of fundus height
5. Lochia b. After delivery, lochia, a vaginal discharge consisting of fatty epithelial cells, shreds of
membrane, decidua, and blood, is red color (lochia rubra) for about 2 or 3 days. It then
progresses to a paler or more brownish color (lochia serosa), followed by a whitish or yellowish
color (lochia alba) in the 7th to 10th day. Lochia usually ceases by 3 weeks, and the placental
site is completely healed by the 6th week
6. Vagina 2. The vaginal walls, uterine ligaments, and muscles of the pelvic floor and abdominal
wall regain most of their tone during the puerperium.
7. Urination 3. Postpartum diuresis occurs between the 2nd and 5th postpartum days, as
extracellular water accumulated during pregnancy begins to be excreted. Diuresis may also
occur shortly after delivery if urinary output was obstructed because of the pressure of the
presenting part(less sensitive of bladder)
8. 4. Breasts a. With loss of the placenta, circulating levels of estrogen and progesterone
decrease while levels of prolactin increase, thus initiating lactation in the postpartum woman. b.
Colostrum, a yellowish fluid containing more minerals and protein and immunologic
component(IgA) but less sugar and fat than mature breast milk and having a laxative effect on
the infant, is secreted for the first 2 days postpartum. c. Mature milk secretion is usually present
by the third postpartum day but may be present earlier if a woman breastfeeds immediately after
delivery. d. Breast engorgement with milk, venous and lymphatic stasis, and swollen, tense, and
tender breast tissue may occur between days 3 and 5 postpartum.
9. Breast milk production
10. Breast engorgement
11. Emotional and Behavioral Status 1. After delivery the woman may progress through Rubins
stages of taking in and taking hold. a. Taking in phase (1) May Begin with a refreshing sleep
after delivery. (2) Woman exhibits passive, dependent behavior. b. Taking hold phase (1) Woman
begins to initiate action and to function more independently. (2) Woman may require more
explanation and reassurance that she is functioning well, especially in caring for her infant. (3) As
the woman meets success in caring for the newborn, her concern extends to other family
members and their activities.

12. Postpartum blue/depression 2. Many women may experience temporary mood swings during
this period because of the discomfort, fatigue, and exhaustion after labor and delivery and
because of hormonal changes after delivery(decrease of Estrogen). 3. Some mothers may
experience postpartum blues at about the third postpartum day and exhibit irritability, poor
appetite, insomnia, tearfulness, or crying. This is a temporary situation. Severe or prolonged
depression is usually a sign of a more serious condition
13. Contributing factors of postpartum blue/depression Difficult of Coping with: a. The physical
changes and discomforts of the puerperum, including a need to regain their prepregnancy figure.
b. Changing family relationships and meeting the needs of family members, including the infant.
c. Fatigue emotional stress, feelings of isolation, and being tied down. d. A lack of time for
personal needs and interests.
14. NURSING ASSESSMENT Immediate Postpartum Assessment The first 1 hour after
delivery of the placenta (fourth stage of labor) is a critical period; post partum hemorrhage is
most likely to occur at this time.
15. Subsequent Postpartum Assessment 1. Check firmness of the fundus at regular intervals. 2.
Inspect the perineum regularly for frank bleeding. a. Note color, amount, and odor of the lochia.
b. Count the number of perineal pads that are saturated in each 8 hour period. 3. Assess vital
signs at least twice daily and more frequently if indicated.
16. Palpating the uterine fundus Firm or *Boggy not palpable by 10 days PP afterpains
Multiparas, multiple births, breastfeeding =>
17. Amount of bleeding
18. Subsequent Postpartum Assessment 4. Assess for bowel and bladder elimination. 5. Assess
for breast engorgement and condition of nipples if breast-feeding. 6. Assess perineal
incisions(episiotomy wound) for signs of infection and healing. 7. Inspect legs for signs of
thromboembolism, and assess Homans sign. 8. Evaluate interaction and care skills of mother
and family with infant.
19. Common site of thrombophlebitis
20. Homans sign
21. NURSING MANAGEMENT Nursing Diagnoses A. Risk for Fluid Volume Deficit related to
blood loss and effects from anesthesia B. Altered Urinary Elimination related to birth trauma C.
Colonic Constipation related to physiologic changes from birth D. Risk for Infection related to
birth process E. Fatigue related to labor F. Pain related to perineal discomfort from birth trauma,
hemorrhoids, and physiologic changes from birth G. Altered Health Maintenance related to lack
of knowledge of postpartum care H. Altered Health Maintenance related to lack of knowledge of
newborn care I. Ineffective Breastfeeding related to lack of knowledge and inexperience
22. Nursing Interventions A. Monitoring for Hypotension and Bleeding 1. Monitor vital signs every
4 hours during the first 24 hours, then every 8 to 12 hours. Observe for the following: a.
Decreased respiratory rate below 14 to 16 breaths per minute may occur.normal b. Increased
respiratory rate greater than 24 breaths per minute may be due to increased blood loss,
pulmonary edema, or a pulmonary embolus. c. Increased pulse rate greater than 100 beats per
minute may be present with increased blood loss, fever, or pain. d. Decrease in blood pressure
15 to 20 mm Hg below baseline pressures may indicate decreased fluid volume or increased
blood loss.

23. A. Monitoring for Hypotension and Bleeding 2. Assess the woman for light-headedness and
dizziness when sitting upright or before ambulating. 3. Assess vaginal discharge for amount and
presence of clots. 4. Evaluate lower extremity sensory and motor function before ambulation if
the woman had regional anesthesia. 5. Encourage food and drink as tolerated. 6. Maintain
intravenous line as indicated. 7. Monitor postpartum hemoglobin and hematocrit.
24. B. Encouraging Bladder Emptying 1. Observe for the womans first void within 6 to 8 hours
after delivery. 2. Palpate the abdomen for bladder distention if the woman is unable to void or
complains of fullness after voiding. a. Uterine displacement from the midline suggests bladder
distention 3. Instruct the woman to void every several hours and after meals to keep her bladder
empty.
25. C. Promoting Proper Bowel Function 1. Teach the woman that bowel activity is sluggish
because of decreased abdominal muscle tone, anesthetic effects, effects of progesterone,
decreased solid food intake during labor, and prelabor enema. 2. Inform the woman that pain
from hemorrhoids, lacerations, and episiotomies may cause her to delay her first bowel
movement. 3. Review the womans dietary intake with her. 4. Encourage daily adequate amounts
of fresh fruit, vegetable, fiber, and at least eight glasses of water. 5. Encourage frequent
ambulation. 6. Administer stool softener as indicated.
26. D. Preventing Infection 1. Observe for elevated temperature above 38. 2. Evaluate
episiotomy/perineum for redness, ecchymosis, edema, discharge (color, amount, odor) and
approximation of the skin. 3. Assess for pain, burning, and frequency on urination. 4. Administer
antibiotics as ordered.
27. Inspection of perineum
28. E. Reducing Fatigue 1. Provide a quiet and minimally disturbed environment. 2. Organize
nursing care to keep interruptions to a minimum. 3. Encourage the woman to minimize visitors
and phone calls. 4. Encourage the woman sleep while the baby is sleeping.
29. F. Minimizing Pain 1. Instruct the woman to apply ice packs to the perineal area for the first
24 hours for perineal trauma or edema. 2. Initiate the use of sitz baths for perineal discomfort
after the first 24 hours a. Use three times a day for 15 to 20 minutes 3. Instruct the woman to
contract her buttocks before sitting to reduce perineal discomfort. 4. Assist the woman in the use
of positioning cushions and pillows while sitting or lying. 5. Administer pain medication as
indicated.
30. F. Minimizing Pain 8. Check the breasts for signs of engorgement (swollen, tender, tense,
shiny breast tissue). a. If breasts are engorged and the woman is breast-feeding: (1) Allow warmto-hot wet towel to over the breasts and massage to improve comfort. (2) Express some milk
manually or by breast pump to improve comport and make nipple more available for infant
feeding. (3) Feeding the infant. (4) A mild analgesic may be used to enhance comfort. b. If
breasts are engorged and the mother is bottle-feeding: (1) Teach the woman to wear a
supportive bra night and day. (2) Teach the woman to avoid handling her breasts, because this
stimulates more milk production. (3) Suggest ice bags to the breasts to provide comport. (4)
Moderately strong analgesics maybe needed to provide comfort.
31. G. Promoting Postpartum Health Maintenance 1. Teach the woman to perform perineal carewarm water over the perineum after each voiding and bowel movement routinely several times a
day to promote comfort, cleanliness, and healing. 2. Promote sitz baths for the same purpose. 3.

Teach the woman to apply perineal pads by touching the outside only, thus keeping clean the
portion that will touch her perineum. 4. Assess the condition of the womans breasts and nipples.
Inspect nipples for reddening, erosions, or fissures. Reddened areas may be improved with A &
D ointment, a lanolin cream, and air drying for 15 minutes several times a day.
32. G. Promoting Postpartum Health Maintenance 5. Teach the woman to wash her breasts with
warm water and No soap, which prevents the removal of the protective skin oils(lanolin). 6. Teach
the woman to wear a bra that provides good support night and day. 7. Instruct the breast-feeding
woman to add between 500 and 750 additional calories daily for milk production.
33. G. Promoting Postpartum Health Maintenance 8. Instruct the woman in postpartum exercises
for the immediate and later postpartum period. a. Immediate postpartum exercises can be
performed in bed. (1) Toe Stretch (tightens calf muscles)- While lying on your back, keep your
legs straight and point your toes away from you, then pull your legs toward you and point your
toes toward your chest. Repeat 10 times. (2) Pelvic floor exercise (tightens perineal muscles)Contract your buttocks for a count of 5 and relax. Contract your buttocks and press thighs
together for a count of 7 and relax. Contract buttocks, press thighs together, and draw in anus for
a count of 10 and relax. b. Exercises for the later postpartum period can be done after the first
postpartum visit.
34. postpartum exercises (1) Bicycle (tightens thighs, stomach, waist)-Lie on your back on the
floor, arms at sides, palms down. Begin rotating legs as if you were riding a bicycle, bringing the
knees all the way in toward the chest and stretching the legs out as long and straight as possible.
Breathe deeply and evenly. Do the exercises at a moderate speed and do not tire yourself. (2) (2)
Buttocks exercise (tightens buttocks)-Lie on your stomach and keep your legs straight. Raise
your left leg in the air, then repeat with your right legs (feel the contraction in your buttocks).
Keep your hips on the floor. Repeat 10 times. (3) Twist (tightens waist)-Stand with legs wide
apart. Hold your arms at your sides, shoulder level, palms down. Twist your body from side to
front and back again. Feel the twist in your waist.
35. Postpartum exercise
36. H. Promoting Health Maintenance of the Newborn 1. Encourage the parents to participate in
daily care of the infant. 2. Advise the parents to attend parenting and baby care classes offered
during their stay at the birth facility mothers class 3. Teach the parents to bathe and diaper the
infant, perform circumcision care, and initiate either breast feeding. 4. Foster bonding by
encouraging skin-to-skin contact with the infant, eye contact, and talking to and touching the
infant.
37. I. Promoting Breast-Feeding 1. Assist the woman and infant in the breast-feeding process. a.
Have the mother wash her hands before feeding to help prevent infection. b. Encourage the
mother to assume a comfortable position, such as sitting upright, tailor sitting, lying on her side.
c. Have the woman hold the baby so that he or she is facing the mother. Common positions for
holding the baby are - the cradle hold, with the babys head and body supported against the
mothers arm with buttocks resting in her hand; - the football hold, in which the babys legs are
supported under the mothers arm while the head is at the breast resting in the mothers hand;
-lying on the side with the baby lying on his/her side facing the mother.
38. cradle hold
39. football hold

40. facing the mother.

41. I. Promoting Breast-Feeding d. Teach the woman to bring the baby close to her, to prevent
back, shoulder, and arm strain. e. Have the woman cup the breast in her hand in a C position
with bottom of the breast in the palm of her hand the thumb on top. f. Have the woman place her
nipple against the babys mouth, and when the mouth opens, guide the nipple and the areola into
the mouth. g. Encourage the woman to alternate the breast she begins feeding with at each
feeding to ensure emptying of both breasts and stimulation for maintaining milk supply. h. Have
the mother breast-feed frequently and on demand (every 2 to 4 hours) to help maintain the milk
supply. i. Have the mother air dry her nipples for about 15 to 20 minutes after feeding to help
prevent nipple trauma. j. Have the mother burp the infant at the end or midway through the
feeding to help release the air in the stomach and make the infant less fretful.
42. I. Promoting Breast-Feeding 2. Alert the mother that uterine cramping may occur, especially
in multiparous women, due to the release of oxytocin, which can be worse in women with
lessened uterine tone. 3. Teach the mother to provide for adequate rest and to avoid tension,
fatigue, and a stressful environment, which can inhibit the letdown reflex and make breast milk
less available at feeding. 4. Advise the woman to avoid taking medications and drugs, because
many substances pass into the breast milk and may affect milk production or the infant.
43. Evaluation A. Vital signs within normal limits; decreasing color and amount of lochia B. Voids
freely and without discomfort C. Lack of constipation; eats high-fiber foods and uses stool
softeners D. Afebrile, no abnormal redness of perineum, no purulent discharge or foul odor of
lochia E. Verbalizes feeling rested F. Verbalizes decreased pain H. Demonstrates confidence in
performing infant care; shows signs of maternal-child bonding I. Demonstrates successful breastfeeding; breasts and nipples infant and without redness or cracks