Postpartum Period

postpartum period is

the 6 to 8 weeks after birth

Vital Signs MAY

take up to 2 weeks to get back to pre-pregnancy rates

Neurological System

once edema subsides returns to normal

Headaches can occur in the first week postpartum,

which could be related to postpartum preeclampsia or leaking of cerebrospinal fluid during the placement of an epidural.

prolactin

hormone produced in the anterior pituitary gland that promotes growth of the mammary alveoli for breast milk production

oxytocin

hormone produced in the posterior pituitary gland that stimulates contraction of the smooth muscle of the uterus and signals the milk ejection reflex of the breast

maternal cardiovascular system

Cardiac Output: Immediately postpartum, there is an increased stroke volume.

Varicosities are enlarged veins that develop when the walls and valves of the veins become weak, and the blood can back up and pool, causing the vein to swell and protrude. Commonly located on legs, ankles or vulva.

maternal hematological system

Blood Volume

Increases throughout pregnancy and declines rapidly during postpartum period.

Changes in blood volume can range from losing up to 500 mL of blood during a vaginal birth and up to 1,000 mL of blood after a cesarean birth

maternal Hemoglobin & Hematocrit

Clotting Factor & Fibrinogen- remains elevated for weeks flowing birth which places which places clients at risk for thromboembolism

White Blood Cells- Due to stress during labor, a client’s white blood cell count can increase to about 25,000/mm3, but it will return to prepregnancy levels within a month postpartum

maternal Pulmonary/Respiratory Systems

function returns to prepregnancy status shortly after birth due to a decrease in intra-abdominal pressure as the diaphragm is no longer being pushed up by the pressure of the fetus and the uterus. Respirations remain between 16 and 24 breaths per minute

White Blood Cell Count

Because of stress during labor, a client’s white blood cell count can increase to about 25,000/mm3, but it will return to prepregnancy levels within a month postpartum.

Birth Blood Loss

Vaginal Delivery 500 Ml

C-Section 1000mL

maternal GI system

Constipation, Hemorrhoids, Anal Incontinence

maternal renal system

Kidney Function

Glomerular filtration rate, renal blood flow, and plasma creatinine decrease to prepregnancy levels by 6 weeks postpartum.

Postpartum Diuresis

occurs and may continue during the first week postpartum the client can urinate up to 3,000 mL a day for the first few days postpartum

maternal bladder Voiding

Can be challenging due to the effects of labor and the use of an epidural for pain management on body sensation and function, which decreases the sensation of needing to empty the bladder. Additionally, perineal pain and selling can make it difficult to urinate in the immediate postpartum period

should be within 6 hours of birth

maternal bladder Distention

The bladder can become swollen and hypotonic for the first 24 hours following birth.

This can be due to the physiological effects of labor along with anesthesia during labor.

Can result in a lack of ability to sense bladder distention

maternal bladder Urinary Incontinence

Approximately 30% of postpartum individuals have urinary incontinence, particularly urge incontinence, which is associated with the stress of birth

Expected Maternal Physiological Adaptations Reproductive System

decreases in size by about 1 cm per day to go back to between the symphysis pubis and the umbilicus by the end of the first week postpartum.

the fundus should

no longer be palpable by the end of 2 weeks postpartum and should return to the nonpregnant size by 6 to 8 weeks postpartum

Lochia is

vaginal bleeding and discharge that occurs in the postpartum period as the uterus sheds debris from pregnancy

lochia rubra

dark red first 3-4 days postpartum

lochia serose

pick to brown days 4-10 postpartum

lochia alba

white or yellow days 10-14 postpartum

Cervix

cervix may be swollen and remain dilated and soft in the immediate postpartum. The cervix will heal within a few weeks postpartum

After a vaginal birth cervical

external os becomes a larger transverse slit instead of the small and round opening that is expected for nulliparous clients. This change is permanent

Ovaries

For postpartum clients who are not lactating, the mean time to return to ovulation is between 45 to 94 days, but it can occur as soon as 25 days postpartum

Vagina

Vaginal epithelium will appear atrophic under microscopic examination

Vaginal walls will appear clear.

Perineum & Pelvic Musculature

The perineum can have spontaneous tears, or an episiotomy may be performed, which can cause pain and long-term health consequences

Breasts Colostrum

is produced during the first few days postpartum.

breast hyperlactation

can be related to excess mammary glandular tissue growth, underlying hormonal signaling, or overstimulation of the breasts or nipples for milk removal

breast hypolactation

can be related to the health status of the lactating person and includes factors such as having diabetes, polycystic ovarian syndrome, or thyroid disorders; taking medications; or smoking.

Musculoskeletal System

Muscle Tone can take weeks or months to strengthen abd. Muscles

Joint Hypermobility back to stability by 8 weeks post-partum

Integumentary System Chloasma/Melasma:

Brownish colored patches on a pregnant client’s face. Also known as the mask of pregnancy. Will lighten during first few months of the postpartum period

Integumentary System Hyperpigmentation of Areola

The areola can become darker during pregnancy and will gradually lighten again postpartum

Integumentary System Linea Nigra

A darkened line running vertically down the middle of the abdomen that is an expected finding caused by increased hormones.

Integumentary System Striae Gravidarum

Commonly called stretch marks and may never disappear postpartum but can become less prominent

Integumentary System Hair Loss

Approximately 3 months postpartum, individuals may notice increased scalp hair loss due to hormone levels returning to prepregnancy patterns and growth and loss cycles.

By 6 to 15 months postpartum, the hair growth will return to prepregnancy thickness

Blood Pressure

High - consider pre-e

low - consider hemorrhage

temperature

increased - consider infection

heart rate

increased - consider hemorrhage

respiratory rate

increased - consider anxiety or compromised respiratory status

decreased - consider use of opiod pain medications

Nursing Care of Postpartum Clients: Physical Assessment: Breasts

Assessed by inspection and palpation to determine if breasts are soft, filling, firm, or engorged (full or hard). Preformed every 8 hours or per organizational policy

Primary engorgement could take place in the first 72 hours postpartum. It is related to interstitial edema and breastmilk coming in.

Secondary engorgement can happen if the newborn is taking in less breastmilk than the maternal client is producing.

Physical assessment of Nipples

Assessed for redness, pain, erectness, and cracks

Breast feeding and Latching should be observed to ensure an appropriate latch and to intervene with the latch if necessary.

The latch should be wide and deep and cover most of the areola, not just the nipple. There should be no pain when the baby latches

Nursing Care of Postpartum Clients: Physical Assessment: Uterine Tone

Checking uterine tone is critical to assess for excessive vaginal bleeding. And is done by Fundal checks per health facility protocol for first 24 hours (discussed in earlier slides)

If the fundus is not firm, nurse should perform fundal massage and emptying bladder can be used to attempt to firm up the uterus

afterpains

pain from the uterus contracting which can be greater during nursing

Perineal Pain

related to vaginal birth and any associated lacerations or episiotomy.

Sitz Bath

A sitz bath is a therapeutic tool that can be used to manage pain and inflammation as well as promoting healing of the perineal tissues and manage hemorrhoids following childbirth.

Cold Therapy

Ice packs or frozen perineal pads can be applied to the perineum for 10 to 20 minutes at a time to help relieve pain and reduce swelling, although evidence of the effectiveness of cold therapy for pain management postpartum is limited

Strengthening Muscles

Specific exercises can help body changes such as diastasis recti and weakened pelvic floor muscles.

Diastasis recti can be treated with physical therapy if it does not resolve at 8 weeks postpartum

Rubella

Measles, mumps, and rubella (MMR) vaccine is contraindicated in pregnancy because of the potential risk to the fetus from a live vaccine.

Tetanus-Diphtheria-AcelIular Pertussis

Key Concept:

Morbidity and mortality from pertussis infection occurs most frequently in newborns under 3 months old since the tetanus-diphtheria-acellular pertussis (Tdap) immunizations are not given until 2 months of age.

Rh Immune Globulin

If a pregnant client has an Rh-negative blood type, it is necessary for them to receive Rh immune globulin to prevent antibody formation. This is done at 28 weeks of gestation and will be given again within 72 hours of birth if the newborn is Rh-positive