Postpartum Physiology & Care
Maria B. Ronquillo, MS,
RNC-OB, C-EFM
Objectives
o
o
o
Describe the maternal anatomic &
physiologic changes that occur during the
postpartum period.
Describe nursing assessments and nursing
care during the postpartum period.
Describe attachment behaviors in parents and
infants, including cultural variations.
Objectives
o
o
o
Differentiate between baby blues and
postpartum depression.
Describe teaching strategies to enhance the
health, comfort and psychological well-being
of the postpartum woman and her family.
Describe the various methods of birth control
and their benefits and risks.
Reproductive System and
Associated Structures
o
o
o
Uterus
n Involution process
n Contractions cause afterpains. These are stronger with
more deliveries. More babies = more pain
n Placental site – where the bleeding comes from.
n Lochia
Cervix
Vagina and perineum
n Pelvic muscular support
Endocrine & Renal Systems
o
Placental hormones
n
o
o
o
Rapid decrease in estrogen and progesterone levels
after expulsion of the placenta is responsible for
triggering anatomic and physiologic changes in
peurperium (postpartum period)
Pituitary hormones and ovarian function
Postpartum diuresis
Urethra and bladder can be injured in delivery.
GI & Breasts
o
o
o
o
Appetite
Bowel evacuation
Breastfeeding mothers
Non breastfeeding mothers
Cardiovascular System
o
o
o
o
Blood volume
Cardiac output
Vital signs
Blood components
n
n
n
n
HCT and HGB
WBC count
Coagulation factors
o Hypercoagulability, vessel damage, and
immobility predispose woman to
thromboembolism
Varicosities
Care of the Postpartum Woman
Fourth Stage of Labor
o
First 1 to 2 hours after birth
n
o
o
Breastfeeding is recommended to begin
Assessment
Post anesthesia recovery:
n
n
Regardless of obstetric status, no woman should
be discharged from recovery area until
completely recovered from anesthesia
Transfer from recovery area
Important Nursing Considerations
o
o
Routine VS and Assessments
Self Care Education
n Pericare (Intact, Laceration, episiotomy)
o Squeeze bottles
o Ice
o Tucks
o Spray (Dermoplast)
o Sitz bath
Important Nursing Considerations
Fundal Massage
n Nutrition, Hydration & Rest
n Breast Care
Pain Management
n Cramping, edema, perineum
n
o
Lochia
Important Nursing Considerations
o
S/S of complications
n
Infection
o
o
o
n
n
n
Uterine
Perineum
breasts
Bleeding
DVT’s
Depression
o
o
Hormonal changes
Sleep disturbances
Care Management
o
Health promotion for future pregnancies and
children
n
n
Rubella vaccination
Prevention of Rh isoimmunization
Care Management
o
Psychosocial needs
n
n
n
n
n
Impact of birth experience
Maternal self-image
Adaptation to parenthood and parent-infant
interactions
Family structure and functioning
Impact of cultural diversity
Transition To Parenthood
Parental Attachment, Bonding,
and Acquaintance
o
Process – this is not instant but rather occurrs
over time
n
n
n
Attachment
Bonding
Does not require immediate contact with the
newborn. Mothers who are separated from infant
often worry.
Diversity in Transitions to
Parenthood
o
Age
n
n
n
n
o
o
o
o
Adolescent mother
Adolescent father
Maternal age greater than 35 years
Paternal age greater than 35 years
Social support
Culture
Socioeconomic conditions
Personal aspirations
Sibling Adaptation
o
o
o
Reactions manifested
in behavioral changes
Involvement in
planning and care
Acquaintance process
Discharge
o
Laws relating to discharge
n
n
o
Newborns and Mothers’ Health Protection Act of
1996
Advantages and disadvantages of early
postpartum discharge
Criteria for early discharge
n
Mother recovered and able to care for self and
baby
Discharge Teaching
o
o
o
o
Self-care; signs of complications
Sexual activity and contraception
Prescribed medications
Routine mother and baby checkups
Discharge Teaching
o
Follow-up after discharge
n
n
n
n
n
Home visits
Telephone follow-up
Warm lines
Support groups
Referral to community resources
Contraception
o
Merck Manual Contraception chart
Any Questions?