Normal Postpartum Study Notes
OB Module 2: Normal Postpartum (Chapters 15 + 16)
Overview of Topics
Physiological Adaptations
Psychological Adaptations
Vital Signs
Cultural Considerations
Nursing Interventions
Nutrition
Reproductive System Changes
Uterus
Involution: The process by which the uterus returns to its non-pregnant size and condition post-delivery.
Uterine atony: A condition where the uterus fails to contract effectively, leading to increased risk of hemorrhage.
Contributing factors: Factors that may influence uterine atony include overdistension (like with multiple pregnancies), prolonged labor, and retained placental fragments.
Cervix
After birth, the cervix gradually closes but may not return to its pre-pregnancy state; it remains somewhat softer and more open.
Vagina
Vaginal walls may appear edematous and bruised initially but will heal and regain tone over time.
Perineum
Healing may take several weeks, especially after an episiotomy or laceration during delivery.
Cardiovascular System Adaptations
Pulse
Normal pulse rate can be significantly lower postpartum (between 60-80 bpm).
Postpartum bradycardia: A lower heart rate that is common and generally not a concern unless accompanied by other symptoms.
Tachycardia: Elevated heart rate may indicate dehydration or blood loss.
Blood Pressure
Decrease postpartum: Generally noted, but high blood pressure (≥ 140/90 mmHg) may be indicative of conditions such as preeclampsia.
Coagulation
Changes during pregnancy enhance coagulation factors, increasing risk for thromboembolic events postpartum.
Risk factors for coagulation disorders include obesity, surgery, and immobility.
Ovulation & Return of Menses
Differentiation: Resumption of menstruation varies between breastfeeding and non-breastfeeding women.
Non-lactating women: Menstruation may resume as early as 7-9 weeks postpartum, or up to 3 months.
Lactating women: The return of ovulation and menstruation depends on breastfeeding duration and frequency.
True or False Question: Ovulation may occur before menstruation resumes.
Psychological Adaptations
Attachment
Parent-infant bonding is critical and can affect the mother's emotional well-being.
Mood Disorders
Postpartum Blues: A common experience that can occur in the days following childbirth, characterized by mood swings and tears.
Phases of Maternal Adaptation
Taking-in Phase
Timing: Birth to 24-48 hours postpartum
Behavior: Mothers exhibit a passive role and dependency.
Taking-hold Phase
Timing: Day 2/3 and can last several weeks
Behavior: Combination of dependent and independent behavior as mothers begin to assume care responsibilities.
Letting-go Phase
Timing: Varies per individual
Behavior: Women experience independent behavior and adapt to their new role as a parent.
Postpartum Vital Signs
Vital Sign Evaluation
Temperature:
First 24 hours may reach up to 100.4°F (38°C); any elevation above this threshold must be reported.
Pulse:
Typically between 60-80 bpm at rest; can drop to 40-60 bpm in the initial days.
Respirations:
Normal range is 12-20 breaths per minute at rest.
Blood Pressure:
Should be monitored; report if it exceeds 140/90 mmHg.
Pain:
The goal is to achieve a pain level of 0-2 on a scale of 10.
Cultural Considerations
"Cuarentena":
A 40-day period of rest observed in Latin American cultures after childbirth.
Emphasis on the balance of hot and cold
postpartum period considered "cold".
Specific dietary recommendations include hot foods and warm water for hygiene.
Restrictions may apply to sitz baths, ice packs, and consumption of raw fruits or vegetables unless warmed.
Nursing Interventions
Promoting Comfort: Techniques like effective pain management and positioning.
Assist with Elimination: Supporting bladder and bowel functions.
Balance of Activity & Rest: Encouraging mobility while ensuring adequate rest.
Promote Safety: Preventing falls and ensuring safe practices.
Nutrition Recommendations
Dietary Guidelines:
Emphasizes variety, suggesting the inclusion of:
Whole grains
Fruits
Vegetables
Legumes
Nuts and seeds
Foods to Avoid: Strongly discouraged are fast foods and high-fat meals.
Fluid Intake: Encouragement to hydrate well postpartum.
Common Routine Postpartum Medications
Pain Relief Medications:
Ketorolac Tromethamine Injection:
15 mg per mL, for intramuscular or intravenous use only; protect from light.
Colace (Docusate Sodium):
A stool softener to promote regular bowel movements.
Acetaminophen:
Extra strength, 500 mg tablets for pain relief.
Ibuprofen:
200 mg caplets for anti-inflammatory action and pain relief.
Ferrous Sulfate:
Iron supplement for postpartum anemia.
Percocet:
Combination of oxycodone and acetaminophen for severe pain management.
Discharge Medications
RhoGAM:
Administered to Rh-negative mothers with Rh-positive newborns to prevent Rh isoimmunization.
MMR Vaccine:
A live vaccine given subcutaneously to protect against measles, mumps, and rubella.
TDAP Vaccine:
Given intramuscularly to protect against tetanus, diphtheria, and pertussis.
Flu Vaccine:
Seasonally administered intramuscularly to protect postpartum women from influenza.