Midwifery Care during Postnatal Period (class 1)

Page 1: Introduction

  • Date: 1427 AH

  • Institution: Princess Nourah bint Abdulrahman University

  • Topic: Physiological Adaptation during Postnatal Period

  • Presented by: Dr. Safaa G. Salem, Ph.D., RN

Page 2: Learning Objectives

  • Objectives of the Lecture:

    1. Define postnatal period and its different stages.

    2. Determine the physiologic adaptation of the woman’s body during the postpartum period.

    3. Discuss major points related to physiological adaptation during the postpartum period.

Page 3: Definition of Normal Postnatal Period (Puerperium)

  • Puerperium: The adjustment period after pregnancy and delivery.

  • Characteristics:

    • Anatomical and physiological changes of pregnancy are reversed.

    • Duration: 6 weeks.

    • The reproductive tract returns to its non-pregnant state after birth.

Page 4: Stages of Puerperium

  • Divisions of Postnatal Period:

    • Immediate Puerperium: First 24 hours post-delivery.

    • Early Puerperium: Extends until the first week postpartum.

    • Remote (Late) Puerperium: Time required for involution of the genital organs until 6 weeks postpartum.

Page 5: Physiologic Adaptation during Postnatal Period

  • The body undergoes significant changes to accommodate the adjustments post-pregnancy.

  • All body systems and organs are affected.

  • Recovery from the stress of pregnancy occurs during the postpartum weeks, as the body returns to its pre-pregnancy state.

Page 6: The Reproductive System

  • Changes:

    • Organs and hormones return to their non-pregnant size and function.

  • Involution: The process whereby the uterus, cervix, and vagina return to their previous state.

Page 7: Uterine Contractility and Involution

  • After placenta delivery, the uterus contracts to seal open blood vessels, preventing postpartum hemorrhage.

  • The clotting cascade is initiated for control of bleeding.

  • Processes:

    • Degeneration of large blood vessels at the placental site replaced by smaller ones.

    • Shedding of decidua and formation of new endometrial tissue without scarring.

Page 8: Assessment of Uterine Involution

  • Uterine measurements:

    • Immediately post-delivery, uterus is firm and midline.

    • Fundus height changes:

      • 1 hour after delivery: at the level of the umbilicus.

      • 1 cm below the umbilicus by the next day, descending about 1 finger breadth daily until papable before the pubic bone within approximately 10 days.

  • Weight return: From pregnancy state back down to about 50-75 grams.

Page 9: Monitoring Uterine Involution

  • Visual: Uterine position over the postpartum period from day 1 to day 9.

Page 10: Factors Promoting Uterine Involution

  • Promoting Factors:

    • Breastfeeding: Stimulates oxytocin release from the posterior pituitary, aiding contractions.

    • Ambulation and Nutrition: Important for normal involution.

  • Inhibiting Factors:

    • Full bladder impedes contractility, pushing the uterus upward.

Page 11: Additional Factors Affecting Uterine Involution

  • Overdistension conditions (e.g., multifetal pregnancy) or maternal exhaustion can hinder contractions.

  • Other inhibiting factors include:

    • Retained placental fragments

    • Infections

    • Grand multiparity (>5 pregnancies)

    • Resulting boggy uterus can lead to hemorrhage.

Page 12: Uterine Afterpain

  • Commonly experienced by multiparas.

  • Afterpain severity contrasts with primiparas, with multiparas experiencing more intense contractions post-delivery.

  • Breastfeeding increases pain duration due to higher oxytocin levels.

Page 13: Lochia

  • Definition: Discharge from the uterus post-delivery.

  • Stages of Lochia:

    • Lochia Rubra: Days 1-4; mostly blood; dark red.

    • Lochia Serosa: Days 4-10; brownish or pink; moderate flow.

Page 14: Lochia Continued

  • Lochia Alba: Begins after day 10; white/yellow discharge from white blood cells.

  • Lochia can last up to 6 weeks post-delivery, and should not contain large clots or abnormal increases.

Page 15: Cervix Post-Delivery

  • Effacement and dilation occur during labor; cervix may remain partly open after delivery.

  • Healing progress: internal os closes in a few days, muscle cells degenerate over 6 weeks.

  • The external os will have a slit-like appearance in comparison to a nulliparous woman.

Page 16: Vagina Post-Delivery

  • May have small tears that heal without intervention.

  • Rugae return in approximately 3 weeks; muscle tone decreases.

  • Breastfeeding impacts estrogen and may lead to dryness and painful relations (dyspareunia).

Page 17: Perineum After Delivery

  • May appear bruised or edematous; healing of episiotomy or tears takes weeks.

  • Edges should be approximated well, but labia will not return completely to pre-pregnancy state.

Page 18: Ovaries Post-Delivery

  • Ovulation can resume as soon as 4 weeks post-delivery; menstruation follows within 6-8 weeks if not breastfeeding.

  • Lactating mothers may experience a longer delay (up to 18 months).

  • Birth control should be considered when sexual activity resumes, especially for those desiring less than immediate pregnancy.

Page 19: Breasts and Milk Production

  • Colostrum: Antibody-rich secretion leading to breast milk.

  • Prolactin rises post-delivery due to the drop in estrogen and progesterone; stimulates milk production beginning on day 2.

Page 20: Cardiovascular System Post-Delivery

  • Blood loss during delivery: 300-500ml (vaginal), over 500ml (C-section).

  • Blood volume normalizes with hemo-concentration increasing the hematocrit level.

Page 21: Cardiovascular and Infection Risks

  • High plasma fibrinogen levels protect against hemorrhage but may increase risk of deep vein thrombosis (DVT).

  • Elevated white blood cell counts (15,000-30,000/ml) help guard against infections following delivery.

Page 22: Vital Signs Post-Delivery

  • Temperature: Slightly elevated in the first 24 hours, >38 degrees post that may signify infection.

  • Blood Pressure: Should remain at baseline; fluctuations can indicate complications.

Page 23: Vital Signs Continued

  • Pulse: Normal to be slow in the first week; tachycardia may indicate difficulties.

  • Postpartum Chills: Shivering occurs due to hormonal changes; resolves quickly.

Page 24: Musculoskeletal System Changes

  • Abdominal muscles may appear soft post-delivery; exercises can aid in regaining tone.

  • Diastasis recti abdominis: Separation of abdominal muscles, common in certain women; can be improved with exercises.

Page 25: Gastrointestinal System Postpartum

  • Women may experience constipation, due to lower abdominal pressure and reduced peristalsis.

  • Fear of defecation due to discomfort may exacerbate issues; usually resolves within the first week.

Page 26: Urinary System Postpartum

  • Increased load results in output exceeding intake; transient glycosuria, proteinuria, and ketonuria might occur.

  • Trauma during labor may lead to temporary loss of bladder control.

Page 27: Urinary System Continued

  • The urinary system remains vulnerable to infection; dilation persists for approximately 4 weeks after delivery due to hormonal effects.

Page 28: Weight Loss Post-Delivery

  • Immediate weight loss: 5-6 kg post-delivery; additional weight loss (2.5 kg) occurs from diaphoresis and urinary loss.

  • Average return to pre-pregnancy weight is around 6 months, with breastfeeding being a contributor to faster weight loss.

Page 29: References

  • Textbooks:

    • Jayne E. Marshall & Maureen D. Raynor (2020). Myles textbook for midwives, 17th edition, Churchill Livingston Elsevier.

    • Jayne N. Klossner (2020). Introductory Maternity Nursing, 15th Edition, Lippincott Williams and Wilkins.

Page 30: Conclusion

  • Date: 1437 AH

  • Institution: Princess Nourah bint Abdulrahman University

  • Message: Thank you!