Postpartum adaptations

Postpartum Period

• Critical transition period for woman, newbron, and family physiologically and psychologically

• Puerperium: period after delivery of placenta, lasting for weeks, ” fourth trimester”

• Possible definition: changes in all aspects of mother’s life that occur during the first year following birth of child

• Maternal physiologic and psychological changes

• mother and family adjustment to new family member

Reproductive system

• Uterus

  • involution: contraction of muscle fibers; catabolism; regeneration of uterine epithelium

  • lochia: rubra, serosa, alba

  • afterpains

• Cervix: closure; now appearing as jagged slit-like opening

• Vagina: eventual thickening and return of rugae

• perineum

Cardiovascular system

• blood volume and cardiac output

• hematocrit level

• pulse rate and bp

• coagulation factors

• rbc production

True or False: 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

Urinary System

• GFR and renal flow increase

• voiding sensation affected by

  • perineal lacerations

  • generalized swelling and bruising of perineum and tissues surrounding the urinary meatus

  • hematomas

  • decreased bladder tone due to regional anesthesia

  • diminished sensation of bladder pressure due to swelling, poor bladder tone, and numbing effects of regional anesthesia used during labor

Postpartum diuresis changes

• Large amounts of IV fluids given during labor

• decreasing antidiuretic effect of oxytocin as its level declines

• buildup and retention of extra fluids during pregnancy

• decreasing production of aldosterone - the hormone that decreases sodium retention and increases urine production

Gastrointestinal changes 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 due to fear of straining affecting the perineum

• hunger and thirst occur du to NPO status prior to delivery

Musculoskeletal System changes postpartum

• joints return to prepregnant state except for feet

• women commonly experience fatigue and activity intolerance for weeks after giving birth

• abdominal tone is diminished after birth and special exercises are needed to return to normal

Integumentary system changes postpartum

• pigmentation fades

• stretch marks fade to silvery lines

• diaphoresis is common for about a week postpartum

Respiratory system changes postpartum

• tidal volume, minute volume, vital capacity, and functional residual capacity return to prepregnant values within 1-3 weeks of birth

• anatomic changes reside quickly

Endocrine system changes postpartum

• estrogen and progesterone levels drop quickly

• placental hormones decline rapidly

• prolactin levels decline within 2 weeks if not breatfeeding

Weight lost postpartum

• excessive weight gain and postpartum weight retention can increase risk of obesity

• rate and amount of weight loss in postpartum period

• breastfeeding on postpartum weight management

Sexual health postpartum

• pelvic rest until first postpartum visit

• postpartum adaptations affect the patients physical wellbeing, mood, relationship, and sexual health

• sexual problems face during this period

Lactation postpartum

• secretion of milk by the breasts

• result on interaction of progesterone, estrogen, prolactin, and oxytocin

• typically appearing 4-5 days after childbirth

• “breast crawl” process

Engorgement Postpartum

• Process of swelling of the breast tissue due to 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

Ovulation postpartum adaptations

• interplay of hormones: estrogen, progesterone, prolactin, and oxytocin

• nonlactating women: return of menstruation 7-9 weeks after birth

• lactating women: return dependent on breast-feeding frequency and duration; anywhere from 2-18 months

Cultural considerations postpartum adaptations

• cultures vary in their postpartum beliefs, practices, and customs

• nurses must be open, respectful, nonjudgemental, and willing to learn about ethnically diverse populations

• understanding various cultures’ views of the postnatal period as it relates to their recovery and well-being after childbirth is important for all nurses

Psychological adaptations postpartum

• attachment: formation of a relationship between a parent and his or her newborn through a process of physical and emotional interactions

• early and sustained contact between newborns and parents is vital

• nurses play a crucial role in assisting with this process of attachment

• factors influencing attachment include environmental circumstances, newborn health, and quality of nursing care

Postpartum mood disorders

• baby blues

  • mild depressive symptoms, anxiety irritability, mood swings, tearfulness, increased sensitivity, fatigue

  • usually peak at days 4-5 and resolve by day 10

• Postpartum depression and 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

4 Stages of Becoming a mother (BAM)

• 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 post birth

• moving toward a new normal

• achievement of a maternal identity through redefining self to incorporate motherhood (around 4 months)