Reproduction on Postpartum Care(1) (1) (1) (1)

Reproduction

• Exemplar 33.3: Discusses postpartum care and the various changes a woman experiences during the postpartum period.

Overview

• Puerperium (Postpartum Period)

  • Begins immediately after birth and lasts for approximately 6 weeks.

  • Women adjust physically and psychologically post-birth.

  • The body undergoes numerous changes to return to a non-pregnant state.

Reproductive System Changes

• Involution

  • The uterus returns to its non-pregnant size.

  • Bleeding is controlled through compressed muscle fibers.

  • Placental site healing takes about 6 weeks.

  • Hormonal changes include decreased estrogen and progesterone levels.

  • Fundus location descends, and the uterus's size becomes prepregnant by about 5-6 weeks.

  • More severe uterine cramping occurs in women who have given birth multiple times.

• Lochia

  • Discharge from the uterus, categorized into:

    • Lochia rubra: Bright red discharge.

    • Lochia serosa: Pinkish-brown discharge.

    • Lochia alba: Yellowish-white discharge.

  • Varies in appearance; typically has a musty, non-offensive odor.

  • Total volume is approximately 225 mL.

• Cervical Changes

  • The cervix appears flabby and admits two fingertips for several days.

  • First childbirth leads to permanent changes in cervical os.

• Vaginal Changes

  • Initially very edematous and bruised.

  • Size decreases and rugae return within 3-4 weeks.

  • Kegel exercises can improve tone and contractility.

• Perineal Changes

  • Edematous and bruised soft tissue.

  • Episiotomy or laceration edges should be approximated, healing takes 2-3 weeks.

• Ovulation and Menstruation

  • Resumes 6-10 weeks after birth if not breastfeeding.

  • In breastfeeding women, it is delayed for up to 3 months, with exclusive breastfeeding reducing pregnancy risk.

Abdominal and Breast Changes

• Abdomen

  • Uterine ligaments stretched, diastasis recti abdominis responds positively to exercise, and striae may remain post-pregnancy.

• Breasts and Lactogenesis

  • Increased estrogen and progesterone during pregnancy stimulate breast development.

  • Post-placenta expulsion, decreased progesterone triggers milk production.

  • Lactation transitions through:

    • Foremilk (high protein, low fat)

    • Hindmilk (rich in fat and calories).

  • Stages of Human Milk:

    • Colostrum: Available at birth.

    • Transitional Milk: Appears 30-72 hours post-birth.

    • Mature Milk: Present by 2 weeks.

Gastrointestinal and Urinary Changes

• Gastrointestinal System

  • Increased hunger and thirst post-birth; bowel movement may be sluggish.

  • No contraindication for oral intake following a Cesarean section.

• Urinary System

  • Increased bladder capacity with swelling and bruising.

  • Presence of puerperal diuresis may lead to urine stasis, increasing UTI risk.

  • Prolonged bladder distention can lead to bladder atony.

Vital Signs and Blood Values

• Vital signs (except first 24 hours) should be afebrile.

  • Blood Pressure: Transient rise post-birth.

  • Bradycardia: Common for 6-10 days post-birth; tremors may occur.

• Blood Values

  • Nonpathological leukocytosis.

  • Platelet levels typically drop post-delivery, hemoglobin, and hematocrit levels need monitoring.

Cardiovascular Changes

• Significant changes occur during birth that can lead to cardiovascular instability.

  • Cardiac output stabilizes within one hour; returns to normal levels within 6-12 weeks.

  • Diuresis occurs during the first 2-5 days; failure can lead to pulmonary edema.

Neurological and Immunological Changes

• Neurological disorders can increase morbidity and mortality risks.

  • Increased likelihood of headaches and seizures, especially in the labor and initial postpartum period.

Psychological Adaptations

• Adaptation for families during the postpartum period involves substantial changes.

  • Mothers may exhibit a range of emotional responses as they adjust physically and psychologically.

  • Ongoing assessment of maternal-infant bonding is crucial.

Nutrition

• Initial weight loss of 10-12 pounds following birth is standard due to the placenta and amniotic fluid expulsion.

• Nutritional requirements post-childbirth vary based on breastfeeding status.

Postpartum Nutritional Status

• Determined by various assessments, including weight, clinical signs, and dietary history.

  • Normal lab values are expected to return within 2-6 weeks post-birth.

  • Risks for obesity may increase during childbearing years.

Nutritional Care of Formula-Feeding Mothers

• Dietary requirements should return to prepregnancy levels.

  • Necessary nutritional education is essential, and referrals to dietitians may be necessary.

Nutritional Care of Breastfeeding Mothers

• Increased nutritional needs exist during breastfeeding, with specific requirements for protein and calcium.

• Important to maintain adequate fluid intake and discuss dietary preferences related to lactation.

High-Risk Postpartum Factors

• Factors affecting postpartum recovery include:

  • Preeclampsia, diabetes, cardiac disease, and cesarean healing needs.

  • Risks of hemorrhage, thrombophlebitis, and other complications related to prolonged labor, difficult birth, or retained placenta.

Nursing Process

• The mother's goals should include:

  • Restoring physical condition, developing infant care skills, and adapting to family life changes.

Data Collection

• Conduct accurate and relaxed assessments during postpartum evaluations.

  • Key focus on physical and psychological assessment of the mother and infant bonding.

Cultural Assessment

• Consider customs and practices regarding postpartum care, foods, and breastfeeding preferences.

Psychological Assessment

• Initial observations may include elation or preoccupation.

  • Provide opportunities for rest and discussions about emotional adjustments.

Assessment of Early Attachment

• Evaluate maternal attachment behaviors such as nurturing and consisting of supportive actions.

Planning & Implementation

• Strategies should include monitoring vital signs, promoting well-being, teaching about infant care and maternal needs, and addressing emotional distress.

Evaluation

• Expected outcomes should focus on the mother’s comfort, understanding self-care, and the parent’s ability to bond with the infant.