Manila Central University

College of Nursing and Midwifery

POSTPARTAL

OVERVIEW
A. ESSENTIAL CONCEPTS B. GOALS OF POSTPARTAL CARE C. FACTORS AFFECTING THE POSTPARTAL EXPERIENCE D.NURSING RESPONSIBILITIES

Postpartum period

ESSENTIAL CONCEPTS
Postpartum period

ESSENTIAL CONCEPTS
POSTPARTUM CARE
Refers to the medical and nursing care given to a patient from the time of delivery until her body returns to near its nonpregnant state
Postpartum period

ESSENTIAL CONCEPTS
PUERPERIUM
Is the 6-week period after delivery Beginning w/ termination of labor and ending w/ the return of the reproductive organs to nonpregnant state A physical and psychological adjustment to the process of childbearing
Postpartum period

ESSENTIAL CONCEPTS
INVOLUTION
Progressive changes in the uterus after delivery Leading to its return to prepregnant state and condition
Postpartum period

ESSENTIAL CONCEPTS
POSTPARTAL PERIOD
Sometimes referred as the fourth stage of pregnancy

Postpartum period

ESSENTIAL CONCEPTS
One aspect of care that commonly suffers w/ the trend toward earlier discharge is support in breast-feeding

Postpartum period

GOALS OF POSTPARTAL CARE

Postpartum period

GOALS OF POSTPARTAL CARE

Promote normal involution and return to the nonpregnant state

Postpartum period

GOALS OF POSTPARTAL CARE

Prevent or minimize postpartum complications

Postpartum period

GOALS OF POSTPARTAL CARE

Promote comfort and healing of pelvic, perianal, and perineal tissues

Postpartum period

GOALS OF POSTPARTAL CARE

Assist in restoration of normal body functions

Postpartum period

GOALS OF POSTPARTAL CARE

Increase understanding of physiologic and psychological changes

Postpartum period

GOALS OF POSTPARTAL CARE

Facilitate newborn care and selfcare by the new mother

Postpartum period

GOALS OF POSTPARTAL CARE

Promote newborns successful integration into the family unit

Postpartum period

GOALS OF POSTPARTAL CARE

Support parenting skills and parentinfant attachment

Postpartum period

GOALS OF POSTPARTAL CARE

Provide effective discharge planning, including appropriate referral for homes care follow-up

Postpartum period

Factors affecting the postpartal experience

Postpartum period

Factors affecting the postpartal experience

Nature of labor and delivery and birth outcome

Postpartum period

Factors affecting the postpartal experience

Preparation for labor and delivery and for parenting

Postpartum period

Factors affecting the postpartal experience

Abruptness of the transition to parenthood Familys individual and collective experiences with childbearing and childrearing Family members role expectation
Postpartum period

Factors affecting the postpartal experience

Sensitivity that increase the risk of postparum complications include:
Preeclampsia or eclampsia DM Cardiac problems uterine overdistension Abruptio placenta or Placenta previa Precipitous or prolonged labor, difficult delivery, extended period of time spent in stirrups
Postpartum period

NURSING RESPONSIBILITIES
Postpartum period

NURSING RESPONSIBILITIES
Provide sensitive professional care to the new parents, which includes:
a. Accurate assessment of mothers physiologic and psychological status b. Anticipatory guidance and health teaching as needed
Postpartum period

NURSING RESPONSIBILITIES
Facilitate the familys bonding experience

Postpartum period

Physiological changes of Postpartum period

POSTPARTAL BIOPHYSICAL CHANGES

A. REPRODUCTIVE SYSTEM B. ENDOCRINE SYSTEM C. CARDIOVASCULAR SYSTEM D. RESPIRATORY SYSTEM E. RENAL & URINARY SYSTEM F. GASTROINTESTINALSYSTEM G. MUSCULOSKELETAL SYSTEM H. INTEGUMENTARY SYSTEM
Postpartum period

REPRODUCTIVE SYSTEM CHANGES REPRODUCTIVE

UTERUS

SYSTEM PERINEUM LOCHIA CHANGES BREAST CERVIX

Postpartum period

VAGINA

REPRODUCTIVE SYSTEM CHANGES:

uterus
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Uterus
Contracts firmly Reducing its size by over ; remains this size for 2 days, then decreases in size (involution) Descends one finger breadth per day
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Uterus
@ 10 to 14 days postpartum cannot be palpated abdominally Returns to nonpregnant state by 4 to 6 weeks postpartum

Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Uterus
Site of placental attachment require - 6 to 7 weeks to heal Endometrial regeneration require 6 weeks
Postpartum period

REPRODUCTIVE SYSTEM CHANGES:

lochia
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Lochia
Discharge from uterus during the first 3 weeks ff. delivery

Postpartum period

Color Lochia rubra Lochia serosa Lochia alba Dark red

Days 1-3

Components Blood & cellular debris from decidua Mostly serum Some blood Tissue debris Leukocytes w/ decidua Epithelial cells Mucus

Pinkish brown Yellowish white

3-10

10-14

Postpartum period

REPRODUCTIVE SYSTEM CHANGES:

cervix
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Cervix
Becomes thicker and firmer By end of first postpartal week dilated 1 cm Complete cervical involution 3 to 4 months Cervical os From round to elongated
Postpartum period

REPRODUCTIVE SYSTEM CHANGES:

vagina
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Vagina
Smooth and swollen w/ poor tone after delivery Rugae
Appear 3 to 4 weeks postpartum

Estrogen index
Return in 6 to 10 weeks
Postpartum period

REPRODUCTIVE SYSTEM CHANGES:

perineum
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Perineum
Appear edematous & bruised after delivery Episiotomy or laceration may be present

Postpartum period

REPRODUCTIVE SYSTEM CHANGES:

abdomen
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Abdomen
Remain soft and flabby Striae remain
But take a silvery-white appearance

Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Abdomen
Diastasis recti
Separation of abdominal recti muscle May occur w/ poor muscle tone

Postpartum period

REPRODUCTIVE SYSTEM CHANGES:

breast
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Breast
Rapid drop in estrogen & progesterone levels w/ increase in secretion of prolactin after delivery

Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Breast
Colostrum
Present @ time of delivery

Breast milk
Produced by 3rd or 4th postpartum day
Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Breast
Becoming larger & firmer
As lactation is established (primary engorgement w/ congestion subsiding in 1 or 2 days

Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Breast
Prolactin stimulates alveolar cells to produce milk

Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Breast
Sucking newborns
contractility of myoepithelial cells to stimulate milk flow (let-down reflex)
Causes oxytocin release &

Postpartum period

REPRODUCTIVE SYSTEM CHANGES

Breast
Average amount of milk produced (24 hrs) increase over time:
First week: 6 to 10 oz 1 to weeks: 20 oz 14 oz = 34 ml After 4 weeks: 30 oz

680 204 ml to 340 ml 1020 ml

Postpartum period

ENDOCRINE SYSTEM CHANGES

Postpartum period

ENDOCRINE SYSTEM CHANGES

Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

ENDOCRINE SYSTEM CHANGES

Ovulation & return of menstruation influenced by:
Lactating
45% resume menstruation by 12 weeks 80% have one or more anovulatory cycles before the first ovulation

Postpartum period

ENDOCRINE SYSTEM CHANGES

Ovulation & return of menstruation influenced by:
Nonlactating
40% resume menstruation by 6 weeks after delivery
65% by 12 weeks & 90% by 24 weeks

50% ovulate during first cycle

Postpartum period

ENDOCRINE SYSTEM CHANGES

Estrogen & Progesterone level
Rapid drop ff. delivery of placenta Responsible for ana. & physio. changes in puerperium

Postpartum period

ENDOCRINE SYSTEM CHANGES

Requirements for rest and sleep increase significantly

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Transient bradycardia
40 to 70 bpm Occurs 24 to 48 hrs after delivery May persist for first 6 to 8 days

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Blood volume
Decreases to nonpregnant levels by 2 weeks after delivery

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Hematocrit level
Rises by 3rd to 7th postpartum day

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Leukocytosis level
20,00 to 25,000 WBC/mL Continues for several days after delivery to prevent infection

Postpartum period

CARDIOVASCULAR SYSTEM CHANGES

Blood pressure
Remains stable

Pulse
Returns to nonpregnant rate by 3 months postpartum
Postpartum period

RESPIRATORY SYSTEM CHANGES

Postpartum period

RESPIRATORY SYSTEM CHANGES

Pulmonary functions return to nonpregnant status by 6 months after delivery

Postpartum period

RENAL & URINARY SYSTEM CHANGES

Postpartum period

RENAL & URINARY SYSTEM CHANGES

Overdistension of bladder
Common due to: Bladder capacity Swelling Bruising of tissues around the urethra Diminished sensation to increased pressure
Postpartum period

RENAL & URINARY SYSTEM CHANGES

Full bladder
Displaces the uterus Can cause postpartum hemorrhage

Bladder distension
Can lead to urinary retention Decrease rapidly after delivery
Postpartum period

RENAL & URINARY SYSTEM CHANGES

Adequate bladder emptying
Generally resumes 5 to 7 days after tissue swelling and bruising resolve

Postpartum period

RENAL & URINARY SYSTEM CHANGES

Glomerular filtration rate
Remains elevated for 7 days after delivery

Postpartum period

RENAL & URINARY SYSTEM CHANGES

Dilated ureters & renal pelvis
Elevated to their nonpregnant state 6 to 10 weeks after delivery

Postpartum period

RENAL & URINARY SYSTEM CHANGES

Puerperal diaphoresis & diuresis
Occur w/in first 24 hrs after delivery

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

Hunger and thirst
Common after delivery

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

GI motility & tone
Return to nonpregnant state w/in 2 weeks after delivery

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

Constipation
Commonly occurs during the early postpartum period

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

Prepregnant weight
Returns in 6 to 8 weeks If weight gain was in N range

Postpartum period

GASTROINTESTINAL SYSTEM CHANGES

Hemorrhoids
Common problem in early postpartal period Due to pressure on the pelvic floor and straining during labor

Postpartum period

MUSCKULOSKELETAL SYSTEM CHANGES

Postpartum period

MUSCULOSKELETAL SYSTEM CHANGES

Ambulate 4 to 8 hrs after delivery
Early ambulation ( ENCOURAGED) to avoid:
Complications Promote involution Improve emotional outlook
Postpartum period

MUSCULOSKELETAL SYSTEM CHANGES

Pelvic articulation
Relaxation and increased mobility Occurs 6 to 8 weeks after delivery

Postpartum period

INTEGUMENTARY SYSTEM CHANGES

Postpartum period

INTEGUMENTARY SYSTEM CHANGES

Melanin
Decrease gradually after delivery Causing decrease in hyperpigmentation

Postpartum period

INTEGUMENTARY SYSTEM CHANGES

Visible vascular changes
Disappear as estrogen levels decrease

Postpartum period

STUDY WELL

Psychological changes of Postpartum period

POSTPARTAL PSYCHOSOCIAL ADAPTATION

A. ESSENTIAL CONCEPTS B. TAKING-IN PERIOD C. TAKING-HOLD PERIOD D. LETTING-GO PERIOD E. POSTPARTUM DEPRESSION
Postpartum period

ESSENTIAL CONCEPTS
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

ESSENTIAL CONCEPTS
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

ESSENTIAL CONCEPTS
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-IN PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-HOLD PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-HOLD PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

TAKING-HOLD PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

LETTING-GO PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

LETTING-GO PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

LETTING-GO PERIOD
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

POSTPARTUM DEPRESSION
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

POSTPARTUM DEPRESSION
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

POSTPARTUM DEPRESSION
Estrogen & Progesterone level
Decrease rapidly after delivery

Postpartum period

Nursing Management of Normal PPP

Nursing Management of Normal PPP

Assessment Nursing diagnoses Planning and Implementation Evaluation

Postpartum period

ASSESSMENT
Postpartum period

NURSING DIAGNOSES
Postpartum period

IMPLEMENTATION
Postpartum period

PLANNING AND

EVALUATION
Postpartum period

References
reference

References

References

References
Maternal & Child Health Nursing 5th edition, 2004 Adele Pillitteri

References
Essentials of Maternity Nursing The nurse and the child bearing family 2nd edition, 1987 Irene M. Bobak Margaret Duncan Jensen
* very understandable

References
Myles Textbook for Midwives 11th edition, 1989 V. Ruth Bennett Linda K. Brown

References
Williams Obstetrics 19th edition, 1993 F. Gary Cunning Paul C. McDonald Norman F. Gant Kenneth J. Leveno Lary G. Guilstrap III

STUDY WELL