postpartum adaptations

postpartum

the period between the birth of the newborn and the return of the reproductive organs to their normal non-pregnant state; generally takes 6 weeks total for the physiologic changes of pregnancy to revert back to non-pregnant state

puerperium

period after delivery of placenta, lasting for 6 weeks, “fourth trimester

what are some endocrine system changes in the postpartum period?

placental hormones decline rapidly; estrogen and progesterone levels drop quickly; prolactin is secreted by anterior pituitary and remains high if lactating and suppresses GnRh release

what is involution?

process of uterus returning to pre-pregnancy state; contraction of muscle fibers, catabolism, regeneration of uterine epithelium

what is subinvolution?

failure of uterus to return to non-pregnant

what is afterpains?

triggered by myometrial contraction; exacerbated by breastfeeding; more severe in multiparous people

what does the cervix do during the postpartum period?

closure; now appearing as jagged slit-like opening

what does the vagina do during the postpartum period?

eventual thickening and return of rugae

what does the perineum/external genitalia do during the postpartum period?

REEDA, assessment of lacerations

what does R in REEDA stand for?

redness; evaluates increased blood flow or inflammation surrounding the incision/laceration

what does the first E in REEDA stand for?

edema; measures local swelling and tissue inflammation around the perineum

what does the second E in REEDA stand for?

ecchymosis; assesses bruising or discoloration of the surrounding skin

what does D in REEDA stand for?

discharge; checks for fluid or discharge from the wound (such as serous, serosanguinous, or purulent drainage)

what does A in REEDA stand for?

approximation; evaluates how closely and securely the edges of the skin and underlying tissues are held together

what is lochia rubra?

deep red color; mixture of mucus, tissue debris, blood; lasts 3-4 days postpartum

what is lochia serosa?

pinkish brown; lasts from 3-10 days postpartum; leukocytes, decidual tissue, red blood cells, serous fluid

what is lochia alba?

final stage; white to light brown; days 10-14 but possibly up to 6 weeks

how much blood loss is normal during lochia assessment?

vaginal birth up to 500 mL; c/s up to 1000mL; expect 6-8 pad changes per day initially

what odor is normal during lochia assessment?

smell similar to menstrual blood

how many clots are normal during lochia assessment?

> size of egg/weigh and notify provider; examine for tissue

describe the process of involution

contraction of uterine muscle fibers; hemostasis is achieved primarily by compression of the intra-myometrial blood vessels as the uterine contracts; lochia sheds → uterine lining regenerates; fundus not palpable by 14 days post birth

what is catabolism?

shrinking of enlarged myometrial cells

what are some factors promoting involution?

oxytocin (pitocin), breastfeeding, fundal massage, urine output, ambulation, hemabate, misoprostol, methergine

what are some factors that inhibit involution?

retained placental fragments, extended IV Pitocin, bredrest, bottle-feeding, tocolytics, precipitous labor, uterine infection, full bladder, coagulopathy

T/F after birth, the cervix returns to its prevaginal delivery birth shape

False; never regains its prevaginal delivery birth appearance. it is no longer circular but appears as a jagged slit-like opening

what areas do tears affect?

cervix, vagina, labia, perineum

what are some CV system adaptations postpartum?

blood volume decreases via diuresis/diaphoresis; CO/SV decrease; hematocrit level dips slightly and then returns to baseline and initial drop in RBC production; pulse rate and BP decrease slightly initially; coagulation factors decrease over 2-3 weeks; WBC elevated

what are some respiratory system adaptations postpartum?

tidal volume, minute volume, vital capacity, and functional residual capacity return to prepregnancy values withni 1-3 weeks of birth; diaphragm returns to normal position; changes in ribcage/thoracic cavity resolve; pregnancy related SOB resolves

T/F the drop in maternal blood volume after birth leads to a similar drop in hematocrit.

false; despite the decrease in blood volume, the hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma

what are some urinary system adaptations postpartum?

GFR renal flow rate decrease over 6 weeks postpartum and tone returns to all urinary tract structures; voiding may be impaired by perineal lacerations, edema/ecchymosis of perineal/uretheral tissue, hematomas, diminished sensation of bladder

describe postpartum diuresis.

decreasing antidiuretic effect of oxytocin; retention of extra fluids during pregnancy in intravascular volume and fluid in tissues; decreasing production of aldosterone = decreased sodium retention = increased urine output; large amounts of IV fluids given during labor leave body

what are some GI system adaptations postpartum?

the GI system quickly returns to normal; relief of pressure on organs; decreased bowel tones for several days; decreased peristalsis occurs; constipation is common d/t fear of straining affecting the perineum; hunger and thirst occur d/t NPO status prior to delivery

what are some musculoskeletal system adaptations postpartum?

decreased sensation r/t anesthesia; joints return to prepregnancy state d/t drop in progesteron, estrogen, relaxin; fatigue and anxiety intolerance common for weeks after giving birth; abdominal muscle tone is diminished after birth and exercises may help to return to non-pregnant state; diastsis recti

what are some integumentary system adaptations postpartum?

pigmentation fades, stretch marks fade to silvery lines, diaphoresis is common for about a week postpartum

describe breast/chest/nipple assessment and care.

initial “fullness” is normal/not tenderness; 72 hours postpartum, primary engorgement; colostrum present; nipples intact if latch wnl; result of interaction of progesterone, estrogen, prolactin, and oxytocin; mature milk production 4-5 days after childbirth; risk of mastitis

what is engorgement?

process of swelling of the breast tissue d/t an increase in blood and lymph supply as a precursor to lactation; relieved by frequent emptying, warm showers and compresses before feeding, cold compresses between feedings, if breast-feeding; tight supportive bra, ice, avoidance of breast stimulation if not breast-feeding

for the postpartum patient who is not breast-feeding the newborn, which measure would be most appropriate to relieve engorgement?

ice to breasts

describe bonding.

unidirectional from parent to infant; starts during pregnancy and is the connection of parent(s) to child; behaviors are en face position, talking, singing, showing affection

describe attachment

bidirectional between parent(s) and infant; starts after birth; behaviors are respond to newborn’s cries, infant responds to comfort measures, entertain/stimulate newborn

what is the taking-in phase?

first phase of rubin’s three phases of maternal psychological adaptation; time immediately after birth when the client needs others to meet her needs and relives the birth process

what is the taking-hold phase?

second phase of rubin’s three phases of maternal psychological adaptation characterized by dependent and independent maternal behavior

what is the letting-go phase?

third phase of rubin’s three phases of maternal psychological adaptation in which birthing parent reestablishes relationships with others

what are the four stages of becoming a mother?

commitment, attachment to unborn baby, preparation for delivery and motherhood during pregnancy; acquaintance/attachment to infant, learning to care for infant, and physical restoration 2-6 weeks postbirth; moving toward a new normal; achievement of a maternal identity through redefining self to incorporate motherhood

describe baby blues.

mild depressive symptoms, anxiety irritability, mood swings, tearfulness, increased sensitivity, fatigue; usually peak at days 4-5 and resolve by day 10

describe postpartum depression/psychosis.

symptoms last longer and are more severe and require treatment; may lead to poor bonding, alienation from loved ones, daily dysfunction, and violent thoughts/actions