This document outlines the phases of puerperium a new mother goes through, including the taking-in phase where she focuses on self-care, the taking-hold phase where she takes responsibility as a mother, and the letting-go phase when she returns home and accepts her new role. It also describes how to conduct a postpartum physical assessment using the acronym BUBBLERS to check the breasts, uterus, bladder, bowel, lochia, episiotomy, Homans' sign, and emotional response. The assessment is meant to identify needs or potential problems and ensure the mother's recovery is progressing normally.

1. POSTNATAL ASSESSMENT
PRANATI PATRA

3. PHASES OF PUERPERIUM
Taking-In Phase
 It takes 2-3 days, during which time the mother’s first
concern is with her own needs (sleep and food).
 The woman reacts passively, mostly dependent on
others to meet her needs.
 She is quite talkative during this phase about every
detail of her labor and delivery experience.

4. Taking-Hold Phase (Taking Responsibility
as a Mother)
 It starts the 3rd day postpartum
 She progresses from the passive individual to the
one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical
being and accepted her role as a mother, she is able
to extend her energies to her mate and other
children.
PHASES OF PUERPERIUM

5. Letting-go Phase
 This generally occurs when the mother returns home.
In this phase there are two separations that the mother
must accomplish.
 One is to realize and accept physical separation from
the infant. The other is to relinquish her former role as a
childless person and accept the enormous implications
and responsibilities of her new situation.
PHASES OF PUERPERIUM

7. PHYSICAL ASSESSMENT
• Physical Assessment is necessary to identify
individual needs or potential problems
• Explain to pt purposes of the examination.
• Obtain her consent.
• Record your findings and report results to the
mother.

8. • Ensure privacy and environment where the mother
can lie on her back with her head supported.
• Ensure bladder is empty & lay patient supine with
legs flexed.
• The midwives hands should be clean and warm

9. POSTPARTUM MATERNAL
PHYSICAL ASSESSMENT
A good method to remember how to check the postpartum
changes is the use of the acronym ‘BUBBLERS’
B: Breast.
U: Uterus.
B: Bladder.
B: Bowel.
L: Lochia.
E: Episiotomy.
H: Homans' sign
E: Emotional response.

10. B: ASSESSMENT OF BREASTS
Inspect for redness & engorgement.
Palpate breasts to determine if they are soft or filling, warm,
engorged or tender.
Teach to promote milk production & let down, and methods to
prevent and treat engorgement.
Advice to use proper bra.
Nipples should be soft, pliable, intact { * If mother is NOT
breast feeding - DO NOT palpate breasts or assess nipples }
Abnormal Findings (Breasts)- Redness, heat, pain, cracked,
and fissured nipples, inverted nipples, palpable mass, painful,
bleeding, bruised, blistered, cracked nipples.

11. U- ASSESSMENT OF THE UTERUS
• Placement and Size (location)
• Tone
• Lochia

12. • Fundal height is measured in cm
above or below the umbilicus
• Note: * fundus is 2 cm below the
level of the umbilicus immediately
after birth
• fundus descends approximately 1 cm
per day; by the 10th day the fundus
should no longer be palpated

16. B: BLADDER
• Marked diuresis is expected for 2-3 days
following delivery: voiding should be
encouraged within 6-8 hrs after labor.
• Ambulate the pt

17. B: BOWEL
• Bowel: there may be no bowel action for a couple of
days because the bowel has probably been emptied
during labor.
• Glycerin suppository may be used to relieve
constipation

18. The acronym ‘REEDA’ is often used to assess an episiotomy or
laceration of the perineum.
E: EPISIOTOMY.

19. • Redness is considered normal with episiotomies and
lacerations
• however, if there is significant pain present, further
assessment is necessary.
• Excessive edema can delay wound healing and the
use of ice packs during the immediate postpartum
period is generally indicated.

20. • Inspect and observe for presence of episiotomy
lacerations, edema, pain or ulceration.
• Only sterile vaginal pads should be used
• Keep the area clean and dry by employing perineal
care.
• use a sitz bath to aid in perineal healing.To avoid
infection
• Teach the mother principals of selfcare.

21. H: Homans' sign
• Homan's sign, is indicative of a deep
vein thrombosis (DVT)
• Negative Homan’s Sign is with No
PAIN
• If there is pain then it is positive (+) and
the nurse needs to report this finding
immediately to the health care provider.
• Press down gently on the patient’s knee
(legs extended flat on bed) ask her to
flex her foot (dorsiflex)

22. E: Emotional response
• sleep deprivation
• ability to rest
• energy level
• comfort level
• anxiety level
• Appetite
• bonding behaviours
• support system (family, husband, self supported)

23. IMMUNIZATION
• Administration of anti–D–gamma
globulin{RhoGAM} to unimmunized Rh-negative
mother bearing Rh-positive baby.
• Women who are susceptible to rubella can be
vaccinated safely with live attenuated rubella virus.
• The booster dose of tetanus toxoid, HepB,should be
given at the time of discharge, if it is not given during
pregnancy