Postpartum Period Study Notes

THE POSTPARTUM PERIOD

OVERVIEW

  • Presenter: Nicole Houser, MSN, RN

LEARNING OUTCOMES

  • The student will:
    • Describe the physiological changes that occur during the postpartum period.
    • Describe normal findings and common deviations found during the head-to-toe postpartum assessment.
    • Identify nursing interventions that enhance physiological return to the pre-pregnant state.
    • Identify nursing interventions that assist in achievement of the goals of the postpartum period.
    • Identify psychosocial needs of the new mother in the early postpartum period.
    • Discuss the process of transition to parenthood.
    • Discuss ways in which to facilitate the process of parent-infant attachment.
    • Identify parental and infant behaviors that promote or inhibit attachment.
    • Explain the three phases of maternal adjustment.
    • Discuss paternal adjustment to new fatherhood.

THE POSTPARTUM PERIOD

  • Also referred to as the fourth trimester.
    • Psychological and physiological readjustment occurs individually.
    • Emphasis on a wellness-based approach to recovery and adaptation.
    • Importance of education in this period.

POSTPARTUM PHYSIOLOGICAL CHANGES

Fourth Stage of Labor
  • Occurs in the 1st 1-2 hours after birth.
  • Body begins recovery from physiological processes of birth and makes initial readjustment to the non-pregnant state.
  • Hormonal Decreases include:
    • Estrogen
    • Progesterone
    • Insulin
FUNDAL HEIGHT
  • Changes throughout the first eight days postpartum:
    • At delivery, the fundal height will be at the level of the umbilicus and typically will begin to decrease as the uterus involutes.
    • Specific measurements will vary per day, reviewed day by day from day 1 to day 8.
PHYSIOLOGIC ADAPTATIONS
  • Uterine Involution:
    • Refers to the decrease in size and weight of the uterus through:
    • Uterine contractions: Crucial for hemostasis.
    • Atrophy and hypoplasia: Involves sloughing of uterine layers to assist in returning to non-pregnant size.
  • Uterine Consistency:
    • Should feel firm; a boggy uterus may indicate complications.
LOCHIA
  • Defined as the vaginal discharge after childbirth, which progresses through three stages:
    • Lochia Rubra:
    • Lasts from the 1st to 4th days post-birth.
    • Flow like heavy menstrual bleeding, may contain small clots.
    • Lochia Serosa:
    • Lasts from the 5th to 9th days post-birth.
    • Flow is moderate to small, less bloody and more watery.
    • Lochia Alba:
    • Lasts from the 10th to 14th days post-birth.
    • Flow is small or spotting, with little to no blood.
  • Evaluation Parameters:
    • Amount of bleeding, characteristics of flow, and danger signals of complications (e.g., foul odor or heavy bleeding).
CERVICAL AND VAGINAL CHANGES
  • Cervical Changes:
    • Changes in the cervical os (or cervical opening).
  • Vaginal Changes:
    • Changes in vaginal rugae (folds).
  • Perineal Changes:
    • General appearance, episiotomy, lacerations, and presence of hemorrhoids.
PELVIC MUSCULATURE AND ABDOMINAL CHANGES
  • Pelvic muscular support might be affected postpartum.
  • Abdominal Changes:
    • General appearance, potential diastasis recti abdominis, and striae (stretch marks).
REPRODUCTIVE FUNCTION
  • Recurrence of Ovulation and Menstruation:
    • Non-breastfeeding mothers typically resume menstruation sooner than breastfeeding mothers.
  • Lactation:
    • Hormonal role of progesterone and estrogen changes during delivery and lactation initiation with prolactin influencing breast changes.
GASTROINTESTINAL SYSTEM CHANGES
  • Symptoms include increased hunger and thirst, sluggish bowel activity, and potential for constipation.
URINARY TRACT
  • Risks include:
    • Overdistention
    • Incomplete emptying leading to urinary retention
    • Postpartal diuresis
CARDIOVASCULAR SYSTEM
  • Vital sign changes may include:
    • Temperature monitoring
    • Blood pressure fluctuations
    • Pulse rate after childbirth.
BLOOD VALUES
  • Parameters include:
    • Blood loss assessment
    • Levels of fibrinogen and white blood cells (WBCs)
    • Hemoglobin and hematocrit (H&H) measurements
    • Monitoring weight loss as an integral recovery metric.
POSTPARTUM CHILL AND DIAPHORESIS
  • Patients may experience feelings of chills or excessive sweating immediately after birth.

INITIAL PHYSICAL ASSESSMENT

  • Check for dangerous predisposing conditions and make special assessments for post-operative situations if applicable.
  • Assessments include:
    • Vital Signs and Pain levels
    • Fundus evaluation
    • Urinary bladder checks
    • Lochia assessment
    • Perineal inspection
    • Examination of hemorrhoids or any surgical incisions.

ONGOING ASSESSMENTS

  • Begin with open-ended questions to facilitate patient interaction and symptom discussions.
  • Monitor:
    • Vital signs and levels of pain
    • Breasts for size, shape, and abnormalities including any cracking or redness
    • Abdomen and uterine status, noting:
    • Fundal height in fingerbreadths
    • Consistency (firm vs. boggy)
    • Any bleeding or clots
    • Lochia for:
    • Characteristics include color, amount, odor, and clots.
    • Perineum examinations for swelling, bruising, and utilization of the REEDA scale for lacerations.
PSYCHOSOCIAL NEEDS
  • Focus on:
    • Impact of the birth experience on mental health.
    • Maternal self-image adjustments.
    • Adaptation to parenthood from both perspectives of the mother and father.
    • Role of family dynamics and cultural influences on postpartum adjustment.

GOALS OF POSTPARTUM CARE

  • Protection and prevention of postpartum complications:
    • Infection
    • Excessive bleeding
    • Maintenance of uterine tone
  • Promotion of comfort through:
    • Non-pharmacologic measures or pharmacologic agents if necessary.
  • Promotion of rest and ambulation to prevent fatigue.
  • Encourage exercise and proper nutritional intake.
  • Facilitate normal bladder and bowel function.
  • Promote effective feeding techniques in the breastfeeding mother.
  • Health promotion and immunizations (e.g., rubella vaccine, Rh immune globulin, varicella vaccine, TDAP, flu vaccine).

DISCHARGE TEACHING

  • Importance of understanding:
    • Early discharge instructions including personal care.
    • Signs of complications to watch for.
    • Instructions related to sexual activity and contraception.
    • Medication guidelines.
    • Nutritional advice and the need for routine check-ups.
    • Availability of support services such as home visits and telephone follow-up.

TRANSITION TO PARENTHOOD

  • Characterized as a dynamic developmental process impacted by:
    • Previous life experiences.
    • The strength and length of the relationship between parents.
    • Financial stability and educational levels.
    • Availability of supportive systems.
    • Desires around parenthood and parental age.
  • Attachment and bonding develop through:
    • Mutuality and reciprocity, physical touch, eye contact, voice recognition, olfactory cues, and communication patterns.
PSYCHOLOGIC ADAPTATION
  • Comprises three phases:
    • Dependent Phase (taking in): New mothers depend on others for reassurance and support.
    • Dependent-Independent Phase (taking hold): Mothers begin to take charge of their own care and the baby's care.
    • Interdependent Phase (letting go): Transition fully into the role of a parent, establishing their own relationship with their child and adjusting to the new family dynamics.
  • Variances in the father's experience of transition including expectations, reality adaptation, and the establishment of mastery and engrossment in parenting tasks.