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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

  1. Taking-in Phase

    • Timing: Birth to 24-48 hours postpartum

    • Behavior: Mothers exhibit a passive role and dependency.

  2. 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.

  3. 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.