Postpartum Physiological Changes

Expected Maternal Physiological Adaptations

Maternal Vital Signs adaption

1-2 weeks to regulate back to normal to pre pregnancy

Nerve compression begins to resolve

with the birth of baby and diuresis of fluid (may have developed during pregnancy due to edema and pressure from the fetus and uterus.) More likey with large baby or twins

Postpartum neuropathy such as weakness and loss of sensation in the lower limbs

may be experienced due to long second stage of labor or lithotomy position (resolves within a few days)

Headaches

can occur during first week can be related to postpartum preeclampsia or leaking of cerebrospinal fluid (spinal headaches) during the placement of an epidural (resolves within a few days)

Endocrine System Placental Hormones

Estrogen & Progesterone levels drop postpartum which signals the anterior pituitary gland to produce prolactin to stimulate breast milk production

HCG human chorionic gonadotropin level will be

zero by the end of the first week postpartum due to expulsion of the placenta

Pituitary Hormones Prolactin

increase and allows for milk secretion from the nipples (lactation).

Without lactation, ovulation will return in as soon as

45 days.

Ovulation may be delayed by as much as

6 months for breastfeeding clients

Prolactin levels do not

remain elevated all the time postpartum but will increase with periods of nipple stimulation, such as suckling by the newborn or breast pumping. No nipple stimulation postpartum, prolactin levels will return to nonpregnant levels within 2 weeks

Pituitary Hormones Oxytocin

production is a response to breastfeeding signaling the milk ejection reflex, which subsequently releases breast milk from the mammary lobe alveoli

Thyroid

levels returns to baseline by 3 months postpartum

Pancrease Insulin and Glucose

drop right after delivery and later regulates

Cardiac Output

return in 1-2 weeks

Varicosities

caused by estrogen, takes about 6 weeks to resolve

Hematological Systems Blood Volume, Hemoglobin & Hematocrit

low h/h from hemodilution (4-6 months to regulate) , loss of vaginal 500 c sec 1000 normal (don’t use H/H for PPH)

Clotting factors/Fibrinogen

remain high watch for DVT (2-3 weeks postpartum)

White blood cells

remain slightly elevated return to normal in a month

Pulmonary Function

shorting after back to normal

Peristalsis, Constipation

are delayed for 2-3 days because of decreased peristalsis, emptying during labor or side effects of pain medications

Hemorrhoids

few days after regular movements occur

Anal Incontinence

4th degree tear, muscles weakened pelvic floor PT

Kidney Function

back to normal in 6 weeks

Postpartum Diuresis

want them to void within 6 hours, 3000 ml/day is normal, 150 ml per void

Bladder Distention

can impede contractility, may need to straight cath, can be because epidural as well

Urinary Incontinence

pelvic floor pt (if retention past 6 weeks send to pt as well )

Involution

the process of the uterus returning to nonpregnant state

Subinvolution

when the uterus fails to return to the nonpregnant state

At 6-12 hours post-delivery fundus

should be at umbilicus or 1 cm above

After umbilicus the uterus should go

down 1 cm every days

Lochia

is the blood that is present after delivery up to 6 weeks

Lochia rubra

is the bright red bleeding known as rubra and is present day 1-4

Lochia serosa

is pinkish-brown and is present days 4-10

Lochia alba

is the whitish-yellow discharge about 2 weeks up to 6 weeks

Cervix os

round for nulliparous, transverses slit of vaginal pregnancy

Vagina

2-3 weeks if no trauma 2-4 week with trauma

Muscle Tone

weeks to months to return esp. abdominal muscles

Joint Hypermobility

8 weeks to return

Integumentary System

Chloasma/Melasma (2 months) , Hyperpigmentation of Areola, Linea Nigra, Striae Gravidarum (life long)

Hair Loss

happens post-partum 6-15 months to return

Phases of Psychological Adaptation Taking in

The client is oriented primarily to their own needs. The primary focus is sleeping and eating. The client may be quite passive and dependent

Phases of Psychological Adaptation Taking hold

The client strives for independence and autonomy. They begin to take care of the baby independently

Phases of Psychological Adaptation Letting go

The client is home and they begin to integrate the baby into their activities

In what ways do the social determinant of health affect adapting to parenting?

check support system, partner family, what kind if home, hob, social services may be need never assume culture.