Unit 2- Postpartum Adaptations

Chapter 20 – pp. 399-429
Chapter 23 – pp. 487-506

Cardiac Output
- There is a transient increase in cardiac output immediately after childbirth due to several physiological changes.
- Excess plasma volume, which can contribute to higher blood volume and pressure, is gradually eliminated through diuresis (increased urination) and diaphoresis (increased sweating).
- Cardiac output typically decreases gradually and returns to normal within 6 to 12 weeks postpartum.
Coagulation
- Following childbirth, there is an increase in clotting factors that predispose the postpartum woman to potential clot formation. This increased coagulation is a physiological adaptation to minimize blood loss during delivery, but may elevate the risk of thrombotic events.

Increased Hunger
- After childbirth, there is an associated increase in hunger which is primarily due to the energy expenditure that accompanies labor and delivery.
Constipation
- Postpartum constipation may occur due to several factors:
- Decreased food and fluid intake during labor, which can lead to lower bowel activity.
- Reduced muscle and bowel tone due to the effects of pregnancy on the gastrointestinal system.
- Fear of pain during defecation, which some women may experience after childbirth.
- The first stool typically occurs 2 to 3 days post-birth.

Diuresis
- Increased urinary output is common postpartum due to normal physiological adaptations.
Urinary Retention
- Postpartum urinary retention can be attributed to:
- Increased bladder capacity which can sometimes lead to difficulty sensing bladder fullness.
- Decreased sensitivity to fluid pressure changes.
Stasis of Urine
- Stagnation of urine can lead to bacterial growth, subsequently increasing the risk for urinary tract infections (UTIs).
- A distended bladder can displace the uterus and potentially lead to excessive bleeding.
Signs of a Distended Bladder
- Location of the fundus above baseline level indicates possible distention.
- Fundus might also be displaced from midline.
- Signs may include excessive lochia, bladder discomfort, a bulge of bladder above the symphysis pubis.
- Frequent voiding of less than 150 ml of urine may indicate urinary retention with overflow.

Muscle and Joint Changes
- The first 1–2 days after childbirth, women often experience muscle fatigue and general aches.
Abdominal Wall
- Diastasis Recti may occur, which is a separation of abdominal muscles.
- Recommended exercises should focus on strengthening abdominal muscles.
Musculoskeletal Discomfort
- Maintaining good posture and proper body mechanics is crucial for recovery.

Skin gradually returns to its non-pregnant state.
Diaphoresis (sweating) increases as the body rids itself of the excess fluids accumulated during pregnancy.
Stretch marks, known as striae gravidarum, may fade, although they do not disappear entirely.
Loss of Hair
- Commonly a normal response to hormonal changes, this tends to begin 4 to 20 weeks after delivery and may be regrown in a duration of 6 to 15 months.

Headache Complaints require careful assessment.
- Bilateral and frontal headaches are common and are often related to changes in fluid and electrolyte balance.
- Presence of spinal headaches may be due to spinal anesthesia effects.
- Symptoms such as blurred vision, photophobia, and abdominal pain could indicate preeclampsia.

Hormones Involved Postpartum include:
- Human Chorionic Gonadotropin (hCG)
- Estrogen
- Progesterone
- Prolactin
- Oxytocin
The resumption of ovulation and menstruation occurs at variable times postpartum.
- Breastfeeding may delay the return of ovulation and menses since it influences hormonal regulation.
- Notably, ovulation may occur prior to the first menstrual cycle.
- Lactation is initiated by Prolactin, which initiates milk production within 2 to 3 days of giving birth.