Postpartum Period

postpartum period

lasts for 6-8 weeks after birth

what does estrogen and progesterone levels signal

anterior pituitary produce prolactin to stimulate milk production

non-lactating mothers..

have normal prolactin levels within 2 weeks

where is oxytocin produced

in posterior pituitary gland

when does oxytocin increase

increases in postpartum period in response to breastfeeding

what does oxytocin do

signals milk ejection reflex releasing breast milk from milk ducts

when do you give insulin

after delivery of the placenta

What decreases in insulin

the insulin requirements and insulin levels

when does insulin sensitization return to pre pregnancy levels

2-3 days after birth

how long does insulin sensitization require

up to 16 wks for individuals who are obese

when is glucose given

in postpartum

when do blood glucose levels return to pre pregnancy

very quickly

Postpartum clients with GDM

should have glucose levels monitored for needed changes in meds or diet

when does blood volume increase

during pregnancy

when does blood volume decline

rapidly during postpartum period

blood loss for vaginal birth

500 mL

blood loss for cesarean birth

1000 mL

what else can happen besides blood loss

rapid diuresis and diaphoresis in postpartum period

• body compensates for the fluid

what is obstetric hemorrhage

blood loss over 1,000 mL within 24hr period

manifestations of hemorrhage

hypovolemia

hemoglobin expected range

12-16 g/dL

hematocrit expected range

37%-47%

when is there a decrease in hemoglobin and hematocrit

first 24 hrs of postpartum and then levels will gradually increase

why do moms WBC count increase

the stress of labor can increase WBC up to 25,000

• will decrease after

fibrinogen levels

always elevated during pregnancy - helps with clotting

what are hemorrhoids

inflamed veins around the anus that can result in pain, pruritis, or bleeding

What increases the risk of hemorrhoids postpartum

clients who experiences vaginal birth, especially if there was a use of instruments during birth

other risk factors of hemorrhoids

• prolonged second stage of labor

• longer duration active pushing

• newborns over 8.8lb

• birth after 40 wks gestation

what can help with constipation

• fluids

• fiber

• colace

how are hemorrhoids treated

resolve on own within days-weeks

• avoid straining

• stay hydrated

• eat fiber

• use wet wipes

• topical cream

why does postpartum diuresis occur

antidiuretic hormone drops

• occurs to rid body of excess fluid

how long can postpartum diuresis occur

can continue during the first week of postpartum

what is diuresis caused by

drop in estrogen after the placenta is delivered

how much can postpartum client urinate

up to 3,000mL a day for first few days postpartum

what can also cause difficulty with urination

perineal pain and swelling

when should the first void be

within 6hr of birth or removal of urinary cath

What should you do after mom urinates

reassess fundus

what can postpartum urinary retention be associated with

prolonged voiding dysfunction and UTI

when should we remove foley cath

when they start pushing for delivery

postpartum clients at risk for urinary retention are

• primigravida

• prolonged labor

• epidural anesthesia

• catheter in labor

• macrosomia newborn

• forceps or vacuum delivery

• perineal or vaginal lacerations

• immobility

how to assess for distended bladder

palpate on pubis or notice displaced uterus or increased lochia

how should the fundus be immediately postpartum

firm, nontender, globular, and located between symphysis pubis and umbilicus

what happens to fundus at 12 hrs postpartum

fundus rises to at or below umbilicus

when does the fundus go back between symphysis pubis and the umbilicus

first week postpartum and shouldn’t be palpable by end of 2nd week

subvolution

uterus not doing what it should be

uterine involution

the progression of the uterus after birth

lochia color changes

changes with the length of time since birth

lochia rubra

day 1-4

• red to dark red

• some clots

lochia serosa

4-10

• pink to light brown

• less thick

lochia alba

10-14 days

• colorless

• white to yellow white

cesarean section lochia

less lochia compared to vaginal

when should mom tell us how often she is changing her pads

when she’s changing them more than 1 pad an hr

size of blood clot they should report

size of golfball or plum

how should the lochia be documented

document of amount of floww on perineal pad after 1 hr

lochia scant

less than 2.5 cm on pad

lochia light

2.5-10cm on pas

lochia moderate

10-15cm on pad

lochia heavy

pad saturated in 1 hr

when to investigate lochia further

when it is foul smelling, unusually heavy flow, large clots

what is lactational amenorrhea

if there is an adequate nipple stimulation from breastfeeding or pumping so mom doesn’t ovulate for first 6 months of postpartum

can a client still ovulate prior to return of menses

yes, means breastfeeding is not a form of birth control

T or F: a woman who is exclusively breastfeeding are unlikely to get pregnant as breastfeeding work as a birth control for 40% of woman

FALSE

is breastfeeding a form of birth control

NO

how often will nurse do vital signs in stage 4 of labor

q15min x8 then q30 x 2 then q 60 x 1 then every 6 hrs

what else needs to be assessed with vitals

fundus, lochia, perineum for swelling

what is primary engorgement

can occur in first 72hrs postpartum - interstitial edema and breast milk coming in

what is secondary engorgement

can happen if newborn is taking in less breast milk than mom is producing after 72 hr

in a breast assessment, what will the nurse look for on the breast for a mother who is breastfeeding

• type of nipple

• blisters

• cracks

• pain

• engorgement

• redness

• how baby latches

• if mothers have had surgeries

how long should mom and partner go without intercourse

6-8 weeks

what should postpartum client be educated on if they are not able to or do not want to breast feed

• limit breast/nipple stimulation

• use cold compresses or cold cabbage leaves on breasts for comfort

• wear well fitted shirts and supportive bra

what are the 3 P's of postpartum psychological disorders

postpartum blues
postpartum depression
postpartum psychosis