The document discusses postpartum adaptations and provides information on: 1. Common postpartum changes such as uterine involution, lochia, perineal changes, and cardiovascular, urinary, and lactation adaptations. 2. Cultural influences and psychosocial factors like attachment, maternal role development, and postpartum mood disorders. 3. Nursing assessments and priorities for postpartum care including physical assessments, teaching self-care, and monitoring for complications like hemorrhage and infection.

1. Postpartum Adaptations
Christine Dunn

2. Healthy People 2020
Increase the proportion of mothers who breast-feed.
Ever breast feeding to one year.
Exclusively up to 6 months.

3. Reproductive System
Uterine involution- umbilicus, 24 hours 1cm.
Descent of the uterine fundus
After pains
Lochia
Cervix
Vagina
Perineum- edematous and bruised.

4. Involution
 Factors which facilitate
involution include complete
expulsion of amniotic
membranes and placenta at
birth, breast-feeding, and
early ambulation.
 Inhibit involution- Prolonged
labor and difficult birth,
incomplete expulsion of
amniotic membranes and
placenta, uterine infection,
overdistention of uterine
muscles, full bladder,
anesthesia, close childbirth
spacing (decreased tone, thus
muscular relaxation). This is
termed subinvolution.

5. Postpartum phase
Lochia- Postchildbirth uterine discharge. Initially
bright red, then changes to pinkish red or reddish
brown. Small clots normal. Immediatley after birth
is bright red (fibrinous products decidual cells, red
and white blood cells)
Rubra- Blood, and trophoblastic debris(tissue from
implantation, deep red, 3-4 days after birth)
Serosa- Pink or brown color, old blood, serum and
leukocytes, and tissue debris. 3-10 days after birth
Alba- Leukocytes, epithelial cells, mucus, serum
and bacteria. White light brown 10 days to 6 week
Nursing interventions (discharge instructions)

6. Cardiovascular System Adaptations
Blood volume-
Pulse and blood pressure- Brady, Tachy?
Coagulation
WBC

7. Urinary System
Profound effects can occur
6 weeks GFR and renal plasma flow back to pre pregnancy.
Risk for several manifestations:
Full bladder can lead to uterine atony which leads to what?
Postpartum diuresis will occur, thus sweating, voiding more
than her usual.
Can be for 4 weeks.

9. Lactation
Estrogen
Progesterone
Prolactin
Oxytocin
Skin to skin contact
Breast milk production summary/ Physiology of lactation
See text

10. Culture and postpartum
How a woman perceives childbirth and the postpartum
period is culturally defined.
Thus know the culture if necessary; ask.
Hot and cold
May need creative strategies.

11. Psychological Adaptations
Attachment- formation of a relationship between a parent
and his or her newborn through a process of physical and
emotional interactions.
Early and sustained contact between newborns and their
parents is vital for initiating their relationship.
Nurses role if vital: assist in the attachment process by
promoting early parent-newborn interactions. Example?
Attachment is complex influenced by: environment,
newborn’s health, quality of nursing care.
Provide clear communication encourage skin to skin, breast
feeding and rooming in.

12. Postpartum Mood disorders
Baby blues- 60-80% Transient last no longer than 2 weeks.
Mom wants to care for herself and her newborn.
Postpartum depression- 15% Sad, overwhelmed, hopeless,
guilty. Does not want to care for newborn or herself.
Postpartum psychosis- psychiatric emergency. Delusional
thoughts. Harm herself or newborn.
Nursing interventions: Educate prior to discharge, know
risk factors and intervene as necessary.

13. Maternal Role Development Theories
Reva Rubin
Phases a mother goes through to adjust to her new
maternal role.
Taking-in Phase- Dependent behaviors during the first 24-
48 hours or so. Longer for primapara.
Taking-Hold Phase- starts second to third day after delivery
and continues for several weeks. Concerned about her
health and the newborn’s condition and her ability to care
for the newborn. Masters her own body functions along
with a desire to take charge with support from others.
Letting –Go Phase- Her lifestyle now includes the infant.
More confident in her role as a mother.
By discharge: Taking Hold. How can we get her there?

14. Nursing management during postpartum
Physical assessment and care important during PP; she
needs a strong social support to help her integrate the baby
into the family.
Family may not live close by, thus the nurse must be a
resource by mentoring, teaching , provide emotional
support.

15. Postpartum Assessments
Chart Review
Vitals- Pulse, Temperature? 100.4?, BP.
Gravada, Para.
Type of delivery
Episiotomy/laceration?/ Fundus location, firm?
Anesthesia or medications
Significant medical/surgical history
Home medications
Allergies
Labs
EBL, Lochia amount? Color, Clots? (Handout)

16. Focused Assessments
Hemorrhage
Infection
Orthostatic Hypotension
Bladder Distention
Perineum

17. Nursing Care
Promoting Bladder Elimination
Analgesics
Privacy
Running Water
Providing fluids
Catheterize if unable to void

18. Preventing Abdominal Distention
Encourage early and frequent ambulation
Abdominal exercises
Avoid carbonated beverages
Simethicone
Rectal suppositories
Analgesics

19. Teaching Self Care
Hand washing
Breastfeeding
Incision care
Perineal care
Kegel exercises
Promote sleep/rest
Nutrition
Good body mechanics
Counseling about sexual
activity

20. Psychosocial Assessment
Focus on emotional status and bonding or
attachment with the newborn.
How does she interact with her family, independent?
Energy level, eye contact
Alert for : mood swings, irritability, crying episodes.
Bonding is a continuation of the relationship that
began during pregnancy. Can be affected by family
hx, role models, support system, culture, birth
experience.
Attachment- strong affection between infant and other

21. Psychosocial attachment
Assessment for attachment: by observing the interaction
Touching, kissing, cuddling, en face position, expressing
pride in Newborn.
Bonding is a vital component of the attachment process
and is necessary in establishing parent-infant attachment
and a healthy, loving relationship.
Attachment is a process, does not occur instantaneously.
Factors affecting attachment see text.

22. Episiotomy
Surgical incision made in the perineum to enlarge the
vaginal outlet.
Types: RML. LML
ML
Use is declining in the US.
Can lead to 4 th degree laceration and large amounts of
pain during the postpartum period.

23. Lacerations
Occur as the fetal head is being born. The extent of
the laceration is defined in terms of its depth.
1. First degree- Extends through the skin and
structures superficial to muscles.
2. Second degree Through muscles of the perineal
body.
3. Third degree- Continues through the anal
sphincter muscle
4. Fourth degree- Involves anterior rectal wall

24. Episiotomy
Care- After delivery
interventions stem
around pain control with
ice, tucks pads, or oral
medications (Colace).
Education on proper
perineal hygiene (sitz) to
prevent infection of the
episiotomy. Washing of
the perineal area with
water after voiding or
defecation is important
to emphasize to the
patient.

25. Lacerations
Vaginal- With perineal lacerations. Lateral walls of
the vagina, and vaginal muscles(levator ani)
Urethral- Lacerated bilateral sides of the urethra.
( precipitus birth)
Cervical- Pushing before completely dilated.

26. Type of feeding
Support her decision of feeding.
Lactation nurses
How to make bottles at home

27. Discharge
Immunizations:
1. Rubella
2. Rh negative; check newborn blood type.
See textbook about Rhogam.
3. Tdap- CDC recommendation.
Home follow-up: phone call.

28. Nursing Diagnosis
Primary postpartum:
How do you prioritize? By what?
Risk for bleeding related to uterine atony.
Stg- soak no more than one pad per hour on my shift
Ltg- patient will understand s&s of bleeding by DC.
Interventions:First?
Evaluations:

29. NR Diagnosis
Risk for infection related to birth process or labor
process.
Stg-
Ltg-
Interventions:
Evaluation:
Risk for injury?
Acute pain related to what?
Impaired tissue integrity related to surgical incision
Risk for ineffective coping related to mood
alteration/pain.

30. NCLEX
Six hours after delivery, the nurse notes that a woman’s
fundus is two cm above the umbilicus and deviated to the
right of the midline. What is the most likely cause of this
finding?
A. Retained placental fragments
B. Bladder distention
C. Normal involution
D. Second-degree uterine atony

31. NCLEX
Which area of health teaching will a new mother be most
responsive to during the taking in phase of the postpartum
period?
A. family planning
B. newborn care
C. community support groups
D. Perineal care

32. NCLEX
The nurse is caring for several immediate postpartum
women. Which client should the nurse attend to first?
A. A woman who had a cesarean delivery asks for
something for pain.
B. A woman who had a vaginal delivery says she needs to
urinate.
C. A woman who infant is nursing says her uterus hurts.
D. A woman says her bed suddenly feels wet beneath her
bottom.