Normal Postpartum

Postpartum

6 weeks after delivery regardless of route of delivery or outcome

Postpartum assessmnet

Assessment, provide comfort and support, identifying signs of complications, promoting health education

Pregnancy-induced hypervolemia

Increased blood volume during pregnancy to support fetal development and maternal needs

Diuresis/Diaphoresis, fluid volume loss

Increased urine output and sweating as the body returns to pre-pregnancy state

Growth in size and vascularity to the uterus

Increased blood flow to the uterus to support the fetus; uterus grows to the size of a large watermelon

Large wound at placental site

About the size of a dinner plate; risk for infection, hemorrhage

Regrowth of endometrial lining; sloughing of decidual tissue

Endometrial lining regenerates after childbirth, accompanied by shedding of decidual tissue

Hormonal changes (Estrogen, Progesterone, Prolactin, Oxytocin)

Occur after childbirth, influence breastfeeding, recovery, and uterine involution

Increased coagulability and venous stasis

Put women at risk for blood clots, embolisms; makes fluid in body harder to move back to upper part of the body

Decrease in diaphragm pressure

Results in increased abdominal pressure, affects respiratory mechanics

Return of immune system to normal

Resumes its pre-pregnancy function, helps protect the body against infections and disease

Perineal trauma

Damage that occurs during childbirth, can lead to pain and complications during recovery

Reduced tone of abdominal muscles

Can lead to decreased core stability and potential issues with posture and movement

Decreased GI motility

Can result in constipation and discomfort during the postpartum period

Blood pressure

Systolic 90-140, diastolic 50-90

Pulse

50-110

Respirations

12-20

Temperature

<100.4˚F

SPO2

≥95

Pain

Subjective, variable, influences affect

Standard prenatal labs

Type and screen, CBC, CMP (maybe), hepatitis B & C, HIV, rubella, RPR serology, GBS

Type and screen

Blood type and Rh factor

CBC

RBC, platelets, WBC, HgB

CMP

Comprehensive medical panel; screens for electrolytes, kidney and liver function

RPR serology

Screens for syphilis

GBS

Screens for group Beta strep, a natural vaginal flora bacteria

BUBBLELE assessment

Breasts, uterus, bowel, bladder, lochia, episiotomy/lacerations, lower extremities, emotions

Involution

Return of the uterus to the pelvic cavity

Teratogens

Agents, such as chemicals and viruses, that can reach the embryo or fetus during prenatal development and cause harm

Breastfeeding breasts assessment

Inspect and palpate for signs of engorgement (tenderness, firmness, warmth, enlargement), proper latch, adequate emptying, expected changes

Non-breastfeeding breasts assessment

Assess for primary engorgement, inspect and palpate for signs of engorgement (tenderness, firmness, warmth, enlargement), no breast/nipple stimulation, ice, no expression

Expected breast assessment findings

Soft and nontender in first 24 hours pp, slightly firm and nontender on pp day 2, firm, tender, and warm to touch on pp day 3

Uterus assessment

Always use both hands to assess to prevent uterine prolapse, assess for location, position, and tone of the fundus (boggy/firm), encourage voiding before assessment so bladder does not move uterus away from midline

Expected uterus findings

Uterus is midline, below the umbilicus, and firm

Bowel assessment

Assess bowel sounds, constipation, hemorrhoids; administer stool softeners as needed; educate on fluid and fiber intake, activity

Bladder assessment

Assist to the bathroom and encourage voiding within 2 to 4 hours postbirth, measure urinary output postbirth (at least 300 mL within 2 to 4 hours of delivery), assess for frequency, urgency, and burning on urination

Lochia assessment

Assess color, amount (scant, light, moderate, or heavy), odor (fleshy odor, smells similar to menstrual blood) clots (occur when lochia has been pooling in the lower uterine segment)

Episiotomy/lacerations assessment

Assessed with fundus and lochia in post-delivery period; assessed every shift using REEDA (redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration)

Episiotomy

Surgical incision of the perineum to enlarge the vagina and facilitate delivery during childbirth

Lower extremities

Assess for venous thrombosis, calves and groin area for tenderness, edema, and warmth each shift, compare pulses in both extremities, mild edema can be normal in first 2-3 days as long as equal bilaterally and not worsening

Emotional state

Assess mood and affect related to circumstances, support or lack of, provide education on postpartum blues

Pain management medications

Tylenol (Acetaminophen), Motrin (Ibuprofen), Oxycodone (Roxicodone), Vicodin (Acetaminophen/Hydrocodone), Percocet (Acetaminophen/Oxycodone), dermoplast spray

Bleeding control medications

Pitocin (Oxytocin)

Other supportive medications

Tucks pads (Witch Hazel), Colace or Pericolace, prenatal vitamins, iron supplements, simethicone (gas pill)

Tdap vaccine

Offered during pregnancy to build fetal antibodies, if did not receive during pregnancy, offer postpartum

Rhogam

Given if mother is Rh – and baby is Rh +, given within 72 hours postpartum (IM)

Bonding

Taking in phase, taking hold phase, letting go phase; en face positioning, calls baby by name, dresses/undresses baby, feeds baby, responds to baby’s cry, rooming in, assuming responsibility for infant care

Taking in phase

Taking hold phase

Letting go phase

Cesarean delivery considerations

Wound, pain, anesthesia (spinal vs. general), foley catheterization, decreased GI motility, decreased mobility, impaired self-care and infant-care, mental and emotional impact if not planned; increased risk for pph, venous thrombolytic events (DVT/PE), pp infections

Discharge teaching

Warning signs, pelvic rest, self care, medication management/side effects, contraception, activity, rest/comfort

Postpartum follow up appointments

All patients get a comprehensive assessment and depression screening at 4 to 6 weeks, high risk patients follow up with primary OB provider at 1 week (or 2 weeks)